Predictors of hypopituitarism due to vasculotoxic snake bite with acute kidney injury
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.
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.
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).
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.
KeywordsHypopituitarism Acute kidney injury Vasculotoxic snake bite
We acknowledge the research grant provided by Endocrine Society of Bengal, a state affiliate of Endocrine Society of India for conducting the study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
- 3.Warrel DA (2010) Guidelines for the management of snake. World Health Organization. https://apps.searo.who.int/PDS_DOCS/B4508.pdf. Accessed 13 Oct 2019
- 4.Antonypillai CN, Wass JA, Warrell DA, Rajaratnam HN. Hypopituitarism following envenoming by Russell's vipers (Daboia siamensis and D. russelii) resembling Sheehan's syndrome: first case report from Sri Lanka, a review of the literature and recommendations for endocrine management.QJM. 2011; 104 (2):97–108.CrossRefGoogle Scholar
- 5.Pe T, Phillips RE, Warrell DA, Moore RA, Swe TN, M Lwin, Burke CW. Acute and chronic pituitary failure resembling Sheehan's syndrome following bites by Russell's viper in Burma. Lancet. 1987; 2(8562):763–7.Google Scholar
- 7.KDIGO Clinical Practice Guideline for Acute Kidney Injury. (2012); 2, Suppl 1. https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf. Accessed 13 Oct 2019