Russell’s Viper Envenomation Complicated by Delayed Hypopituitarism and Multiple Endocrine Dysfunction

Abstract

Girin Ray and Debmalya Sanyal

Russell’s viper envenomation can cause severe systemic complications, including a rare but significant long-term endocrine sequela: hypopituitarism. The delayed onset and non-specific nature of symptoms often lead to diagnostic challenges and prolonged patient morbidity. We report the case of a 32-year-old male farmer who presented with progressive and debilitating symptoms of fatigue, weight loss, and reproductive dysfunction 18 months following a severe Russell’s viper bite complicated by acute kidney injury. A thorough endocrine evaluation confirmed pan hypopituitarism, with laboratory results demonstrating multiple anterior pituitary hormone deficiencies, including secondary adrenal insufficiency, hypothyroidism, and hypogonadism. This case highlights the critical importance of maintaining a high index of clinical suspicion for hypopituitarism in individuals with a history of severe Russell's viper envenomation. Long-term endocrine surveillance is essential for all survivors, as early recognition and timely hormone replacement therapy are crucial for preventing life-threatening adrenal crises and significantly improving long-term quality of life.

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