신증후성 출혈열 후 발생한 뇌하수체 기능저하증 1례

Abstract

Hemorrhagic fever with renal syndrome (HFRS) caused by hantaviruses is a systemic infection with fever, hypotension, hemorrhage and acute renal failure. Pituitary hemorrhage and necrosis are causes of hypopituitarism often remaining undetected due to subtle clinical symptoms. We report on a patient who developed hypopituitarism as a late complication of HFRS 40 years later. His representative symptoms and signs were weakness, slurred speech, apathy, decreased muscular strength and decreased thyroid function test, which revealed low free T4 with normal thyroid stimulating hormone consistent with secondary hypothyroidism. Combined pituitary stimulation tests confirmed hypopituitarism and magnetic resonance imaging of the pituitary revealed atrophic pituitary gland with an empty sella. This report suggests that patients who have recovered from HFRS is at risk of developing hypopituitarism and should be diagnosed and treated appropriately if suspected because unrecognized hypopituitarism significantly affects patient’s quality of life.