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Hormonal deficiencies during and after Puumala hantavirus infection

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Abstract

Previous reports have described panhypopituitarism associated with severe cases of hemorrhagic fever with renal syndrome (HFRS), but the prevalence of hormonal deficiencies after nephropathia epidemica (NE), a milder form of HFRS, has not been studied. This study was conducted in order to determine the prevalence of hormonal defects in patients with acute NE and during long-term follow-up. Fifty-four patients with serologically confirmed acute NE were examined by serum hormonal measurements during the acute NE, after 3 months, and after 1 to 10 (median 5) years. Thirty out of 54 (56%) patients had abnormalities of the gonadal and/or thyroid axis during the acute NE. After a median follow-up of 5 years, 9 (17%) patients were diagnosed with a chronic, overt hormonal deficit: hypopituitarism was found in five patients and primary hypothyroidism in five patients. In addition, chronic subclinical testicular failure was found in five men. High creatinine levels and inflammatory markers during NE were associated with the acute central hormone deficiencies, but not with the chronic deficiencies. Hormonal defects are common during acute NE and, surprisingly, many patients develop chronic hormonal deficiencies after NE. The occurrence of long-term hormonal defects cannot be predicted by the severity of acute NE.

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Acknowledgments

There is no conflict of interest and nothing to declare. This work was supported by the Competitive Research Funding of the Pirkanmaa Hospital District, by the Finnish Kidney Foundation, and by the European Commission Project “Diagnostics and control of rodent-borne viral zoonoses in Europe” (QLK2-CT-2002-01358). We thank Jukka Partanen for the analyses of HLA alleles and Esko Väyrynen for the language revision. The skilful technical assistance of Heidi Hällström, Katriina Ylinikkilä, and Mirja Ikonen is greatly appreciated.

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Authors and Affiliations

  1. Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland

    S. Mäkelä, P. Jaatinen, J. Salmi, I. Ala-Houhala, I. Pörsti & J. Mustonen

  2. Medical School, University of Tampere, 33014, Tampere, Finland

    S. Mäkelä, P. Jaatinen, I. Ala-Houhala, M. Hurme, I. Pörsti & J. Mustonen

  3. Department of Internal Medicine, Central Hospital of Jyväskylä, Keskussairaalantie 19, 40620, Jyväskylä, Finland

    M. Miettinen

  4. Tampere School of Public Health, University of Tampere, 33014, Tampere, Finland

    H. Huhtala

  5. Department of Virology, Haartman Institute, University of Helsinki, P.O. Box 21, 00014, Helsinki, Finland

    A. Vaheri

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  1. S. Mäkelä
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Mäkelä, S., Jaatinen, P., Miettinen, M. et al. Hormonal deficiencies during and after Puumala hantavirus infection. Eur J Clin Microbiol Infect Dis 29, 705–713 (2010). https://doi.org/10.1007/s10096-010-0918-y

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