Analysis of fatal outcome in hemorrhagic fever with renal syndrome

The analysis of 88 lethal outcomes of hemorrhagic fever with renal syndrome (HERS) showed the occurrence of adenohypophyseal hemorrhage and necrotic foci in 75.5% of cases as well as combined involvement of adenohypophysis and adrenals in 18.4%. Pathogenetically, adenohypophyseal affection is related to anatomical-physiological features of the vessels, microcirculatory disorders, acute venous congestion. Contributing factors may be acute DIC syndrome, relapsing and prolonged collapses, hyperhydration leading to brain edema and hemostasis. Uncontrollable vomiting recorded in all the deceased patients seemed to promote destruction of adenohypophysis. Clinically, this gross pathomorphology ++ was equivalent to severe form of the disease--hypopituitary coma. Proper prophylaxis of the above complications is one of the conditions entailing reduction of mortality in HFRS.