Context: Hemorrhagic fever with renal syndrome (HFRS) caused by hantaviruses, is a severe systemic infection, with acute shock, vascular leakage, hypotension and acute renal failure. Pituitary ischemia/infarction and necrosis are known causes of hypopituitarism often remaining unrecognized due to subtle clinical manifestations. Cases of hypopituitarism following HFRS were previously only sporadically reported.

Objective: The aim of this study was to determine, for the first time, the prevalence of hypopituitarism among HFRS survivors.

Subjects and methods: In 60 adults (age, 35.8±1.3yrs) who recovered from HFRS 3.7±0.5yrs ago (median, 2yrs) assessment of serum T4, fT4, TSH, IGF-I, PRL, cortisol, and testosterone (in males), was followed by ITT or/and GHRH+GHRP-6 stimulation tests.

Results: Severe GH deficiency was confirmed in 8/60 (13.3%) patients; in five with multiple pituitary hormone deficiencies (MPHD) and isolated in three. Thyroid axis deficiency was confirmed in 5/60 patients (8.3%), all with MPHD. HPA axis deficiency was observed in 6/60 (10.0%); in five with MPHD and isolated in one. Gonadal axis deficiency was confirmed in 7 (12.5%) of 56 male subjects; in five with MPHD and isolated in two. Overall 6 patients (10.0%) had a single pituitary deficit (3 GH, 2 gonadal, and 1 adrenal), and 5 (8.3%) had MPHD. The prevalence of patients having any endocrine deficiency was 18% (11/60).

Conclusion: A high prevalence of hypopituitarism after recovery from HFRS, is identified, with MRI revealing atrophic pituitary and empty sella. Awareness is raised to neuroendocrine consequences of HFRS, since unrecognized hypopituitarism significantly affects the physical and psychological well-being.