Predictors of hypopituitarism due to vasculotoxic snake bite with acute kidney injury

• Published in: Pituitary Vol. 22; no. 6; pp. 594 - 600
• Main Authors: Bhat, Sowrabha, Mukhopadhyay, Pradip, Raychaudhury, Arpita, Chowdhury, Subhankar, Ghosh, Sujoy
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2019; Springer Nature B.V
• Subjects: Acute Kidney Injury - complications; Acute Kidney Injury - metabolism; Adrenocorticotropic hormone; Adult; Blood coagulation; Clotting; Cortisol; Diabetes insipidus; Endocrinology; Female; Follicle-stimulating hormone; Hemodialysis; Human Physiology; Humans; Hypopituitarism; Hypopituitarism - diagnosis; Hypopituitarism - etiology; Hypopituitarism - metabolism; Insulin-like growth factor I; Kidneys; Logistic Models; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Pituitary; Pituitary Gland - metabolism; Pituitary Gland - pathology; Prevalence; Prolactin; Prospective Studies; Renal Dialysis; Snake bites; Snake Bites - complications; Snake Bites - metabolism; Snakes; Testosterone; Hypopituitarism; Acute kidney injury; Vasculotoxic snake bite
• ISSN: 1386-341X; 1573-7403; 1573-7403
• DOI: 10.1007/s11102-019-00990-8

Purpose Hypopituitarism frequently develops following vasculotoxic snake bite complicated by acute kidney injury (AKI). Well defined prospective studies of prevalence of hypopituitarism and its predictors in vasculotoxic snake bites complicated by AKI are unavailable. Methods Fifty-one consecutive patients of AKI following vasculotoxic snake bite were evaluated for various clinical/biochemical parameters (including Free T4, TSH, Cortisol, ACTH, total testosterone, FSH, LH, prolactin, and IGF-1). Diabetes insipidus was evaluated in relevant cases. Twenty minutes whole blood clotting time (WBCT) at presentation was measured in all. MRI of hypothalamo-pituitary region was done at 3 months in subjects with hypopituitarism to rule out structural lesion. Results 21.6% (11/51) patients developed hypopituitarism at baseline (within 7 days), 39.3% (13 /33) at 3 months developed hypopituitarism. Cortisol deficiency was the commonest abnormality. Subjects who developed hypopituitarism at baseline were younger compared to those without hypopituitarism (35.67 years vs. 46.59 years, p = 0.032) and required more sessions of hemodialysis (8 vs. 3, p = 0.041). Binary logistic regression confirmed that development of hypopituitarism could be predicted by increased number of sessions of hemodialysis (OR 1.51, p = 0.008) and 20 min WBCT (OR 1.2, p = 0.038). Conclusion Hypopituitarism is common following vasculotoxic snake bite in subjects who develop AKI requiring hemodialysis. Hypopituitarism can develop as early as 7 days following snake bite and should be evaluated for particularly in younger subjects, especially those requiring increasing number of sessions of hemodialysis and in subjects with abnormal 20 min WBCT at presentation.