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Pituitary atrophy in Korean (epidemic) hemorrhagic fever: CT correlation with pituitary function and visual field
Insights
Korean hemorrhagic fever can cause pituitary gland atrophy and visual field defects. High-resolution CT scans revealed these changes, correlating with impaired pituitary function and vision loss in patients.
Area of Science:
- Neurology
- Radiology
- Endocrinology
Background:
- Korean (epidemic) hemorrhagic fever is a serious viral illness.
- The pituitary gland's function can be affected by systemic diseases.
- High-resolution computed tomography (CT) is a valuable imaging tool for evaluating the pituitary gland.
Purpose of the Study:
- To investigate pituitary gland necrosis in patients with Korean hemorrhagic fever using high-resolution CT.
- To correlate CT findings with pituitary function and visual field deficits.
- To understand the pathogenesis of these complications.
Main Methods:
- Eleven patients with Korean hemorrhagic fever underwent three high-resolution CT scans.
- Pituitary gland height was measured on CT scans to assess for atrophy.
- Visual fields were tested, and pituitary function tests were performed.
- Follow-up examinations assessed changes over time.
Main Results:
- Seven out of eleven patients showed progressive pituitary gland height decrease (atrophy).
- Six patients experienced bitemporal superior quadrantanopsia (visual field defects).
- Pituitary atrophy and visual field defects were coincidental in five patients.
- Five of six patients with atrophy showed decreased pituitary reserve function (FSH, cortisol, or GH).
Conclusions:
- High-resolution CT can demonstrate pituitary gland atrophy in Korean hemorrhagic fever.
- Pituitary atrophy and visual field defects are likely due to ischemic necrosis.
- Optochiasmatic and pituitary ischemia are suggested as the underlying pathogenesis.
Abstract:
Eleven patients with Korean (epidemic) hemorrhagic fever were each studied three times with high-resolution CT in order to demonstrate necrosis of the pituitary gland and to correlate the CT findings with the patients' pituitary function and visual fields. Seven of the 11 patients showed varying degrees of progressive decrease in the height of the pituitary gland: one severe, two moderate, and four mild. The visual fields of all the patients were checked at the time of the third (last) follow-up CT. Six of the 11 patients had bitemporal superior quadrantanopsia. In five patients, the decreased height (atrophic change) of the pituitary gland and the visual-field defect were coincidental. The visual-field defects in those patients were not improved on follow-up examination 5 weeks later. Two patients in whom a 1-year follow-up examination was performed showed no interval changes in the defects. Pituitary function tests were performed in nine of the 11 patients (six with atrophic pituitary glands and three without atrophic changes) at the time of the third CT. Five of the six patients with atrophy showed decreased pituitary reserve function for follicle-stimulating hormone, cortisol, or human growth hormone, while only one patient showed decreased reserve function for cortisol among the three patients without atrophic change. The pituitary atrophic changes observed on follow-up sellar CT are thought to be the result of the ischemic necrosis of the gland. The high probability (five of seven) of visual-field defects in those patients with atrophic glands suggests optochiasmatic and pituitary ischemia as the basic pathogenesis.