Lichtenstein M J, Tilley W S, Sandler M P
J Endocrinol Invest. 1982 Mar-Apr;5(2):111-5. doi: 10.1007/BF03350501.
Diffuse hypothalamic-hypopituitarism complicating viral meningoencephalitis has been rarely documented. In this report, we describe the syndrome in a 41 yr old male and review the literature. Detailed endocrine studies were performed 1 month after the onset of apparent viral encephalitis. Repeated 08:00 h serum cortisol levels were low, but increased after administration of lysine-vasopressin. Urine 17-hydroxy-corticosteroid (17-OHCS) values rose with prolonged cortrosyn infusion, but failed to respond after administration of metyrapone. Serum thyroxine was decreased; basal levels of serum thyrotropin were low-normal, but there was a prolonged response to tyrotropin (TSH) to thyrotropin releasing hormone (TRH). Basal prolactin was elevated with a minimal response after TRH. Testosterone and gonadotropins were both diminished, and gonadotropins increased (but less than in normal subjects) after injection of gonadotropin releasing hormone (LHRH). The overnight water deprivation test confirmed the presence of diabetes insipidus. In the present context, the abnormal endocrine investigations were strongly supportive of disturbed hypothalamic activity. Hypothalamic-hypopituitarism following viral meningoencephalitis may occur more frequently than previously reported, and thus basal pituitary function should be assessed in all patients with viral meningoencephalitis.
弥漫性下丘脑 - 垂体功能减退并发病毒性脑膜脑炎的情况鲜有文献记载。在本报告中，我们描述了一名41岁男性的该综合征并回顾了相关文献。在明显的病毒性脑炎发病1个月后进行了详细的内分泌研究。上午8点的血清皮质醇水平反复偏低，但在给予赖氨酸加压素后升高。尿17 - 羟皮质类固醇（17 - OHCS）值在长时间输注促肾上腺皮质激素后升高，但在给予甲吡酮后无反应。血清甲状腺素降低；血清促甲状腺激素基础水平略低，但对促甲状腺激素释放激素（TRH）的促甲状腺激素（TSH）反应延长。基础催乳素升高，TRH后反应微弱。睾酮和促性腺激素均降低，注射促性腺激素释放激素（LHRH）后促性腺激素升高（但低于正常受试者）。禁水过夜试验证实存在尿崩症。在当前情况下，异常的内分泌检查强烈支持下丘脑活动紊乱。病毒性脑膜脑炎后的下丘脑 - 垂体功能减退可能比以前报道的更常见，因此所有病毒性脑膜脑炎患者都应评估垂体基础功能。
