Hypopituitarism in a Dengue Shock Syndrome Survivor without known Pituitary Adenoma
- Author:
Lim, L.L.
;
Ibrahim, L.
;
Paramasivam, S.S.
;
Ratnasingam, J.
;
Chan, S.P.
;
Tan, A.T.B.
;
Vethakkan, S.R.
- Publication Type:Journal Article
- From:Tropical Biomedicine
2016;33(4):746-752
- CountryMalaysia
- Language:English
-
Abstract:
Dengue infection is endemic in South East Asia and parts of the Americas. Dengue
hemorrhagic fever is characterized by vascular permeability, coagulation-disorders and
thrombocytopenia, which can culminate in hypotension i.e. dengue shock syndrome.
Hypopituitarism arising as a complication of dengue is extremely rare. Hemorrhagic pituitary
apoplexy of pre-existing pituitary adenomas has been rarely reported in dengue. We describe
an uncommon case of hypopituitarism in a dengue shock syndrome survivor without known
pituitary adenoma. A 49 years old nulliparous lady (from Kuala Lumpur, Malaysia) presented
with typical symptoms of hypocortisolism. Postural hypotension was evident with normal
secondary sexual characteristics. Further history revealed that she survived an episode of
dengue shock syndrome 6 years ago where premature menopause developed immediately
after discharge, and subsequently insidious onset of multiple hormonal deficiencies indicative
of panhypopituitarism. There were no neuro-ophthalmological symptoms suggestive of pituitary
apoplexy during hospitalization for severe dengue. Magnetic resonance imaging of the pituitary
6 years later revealed an empty sella. Autoimmune screen and anti-thyroid peroxidase
antibodies were negative. We describe a rare possible causative association of severe dengue
with panhypopituitarism without known pituitary adenoma, postulating pituitary infarction
secondary to hypotension (mimicking Sheehan’s syndrome), or a direct viral cytopathic effect.
Subclinical pituitary apoplexy secondary to asymptomatic pituitary hemorrhage however
cannot be excluded. Future research is required to determine the need for and timing of
pituitary axis assessment among dengue shock syndrome survivors.
- Full text:P020170123562280255392.pdf
