A Case Report of Empty Sella Syndrome secondary to Hantaan Virus Infection and Review of the Literature

Abstract Background Bleeding in the anterior pituitary lobe leading to tissue necrosis occurs in acute stage of severe clinical forms of hemorrhagic fever with renal syndrome (HFRS), while atrophy of the anterior pituitary lobe with diminution of the gland function occurs after recovery stage. The relationship between hantaan virus infection and empty sella syndrome (EES) was reported rarely. Case presentation We herein report a case of EES secondary to hantaan virus infection. This patient was a 54-year-old previously healthy Chinese male. He presented with fever, headache and backache with dizziness and oliguria. Physical examination was notable for hypotention and the signs of conjunctival suffusion. His platelet dropped and the urine protein was positive. The IgM to Hantaan virus and virus RNA were positive. Then he was diagnosed as hemorrhagic fever with renal syndrome. But in his diuretic phase, his 24-hour urine volume was still kept on the level of 10, 000 ml and his blood pressure was obviously higher for a week. Then the examination of pituitary function and brain magnetic resonance imaging were performed. The levels of the hormones were much lower and the magnetic resonance imaging results indicated empty sella. The patient’s symptoms were improved and he was discharged from the hospital soon after hormone replacement therapy. Conclusions The examination of pituitary function and MRI of brain need to be considered to scan ESS and panhypopituitarism in the patients with HFRS accompanied with diabetes insipidus.