Panhypopituitarism and Central Diabetes Insipidus Almost Three Decades After Russell's Viper Envenomation: A Remarkable Case Report and Literature Review

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Ritwik Ghosh Moisés León-Ruiz Dipayan Roy Sona Singh Sardar Srijit Bandyopadhyay Kunal Bole Souvik Dubey Julián Benito-León


Background: Snakebite is a preventable yet often-neglected public health hazard with high chronic disability and mortality, mainly faced by rural communities in the tropics/subtropics. Endocrinological disorders following snakebite (especially Russell's viper in India) are notably underrecognized and can lead to remarkable morbidity, poor quality of life, and cardiovascular mortality. Anterior pituitary insufficiency has been the most common ailment following Russell's viper envenomation amid those endocrinological dysfunctions. On the contrary, the posterior pituitary and nearby hypothalamus mostly remain unharmed, so central diabetes insipidus is extremely rare following a viperid snakebite envenomation.

Case Presentation: The authors present a patient developing panhypopituitarism with evident spontaneous central diabetes insipidus 29 years after Russell's viper envenomation. Relevant investigations ruled out other possible etiologies, and he responded well to hormonal replacement therapy.

Conclusions: Panhypopituitarism with concurrent central diabetes insipidus may occur following snakebite (especially in Russell's viper envenomation). Early recognition and proper management of these complications are quintessential to preventing further misdiagnosis, under-recognition, morbidity, impaired quality of life, and mortality.


Keywords: Panhypopituitarism, central diabetes insipidus, Russell's viper envenomation

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How to Cite
GHOSH, Ritwik et al. Panhypopituitarism and Central Diabetes Insipidus Almost Three Decades After Russell's Viper Envenomation: A Remarkable Case Report and Literature Review. Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 21 july 2024. doi:
Case Reports


1. Ghosh R, Maity A, Biswas U, et al. Lance-Adams syndrome: An unusual complication of snakebite envenomation. Toxicon. 2022;209:50-55
2. Lancet T. Snakebite envenoming: a priority neglected tropical disease. Lancet. 2017; 390:2.
3. Bhattacharya S, Krishnamurthy A, Gopalakrishnan M, et al. Endocrine and Metabolic Manifestations of Snakebite Envenoming. Am J Trop Med Hyg 2020;103(4):1388-1396.
4. Antonypillai CN, Wass JA, Warrell DA, et al. 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.
5. Hart GR, Caldwell G, Burrin JM. Intracellular mechanisms involved in the stimulation of growth hormone release from rat anterior pituitary cells by Russell’s viper venom. J Endocrinol. 1990;127(1):111-117.
6. Gopalakrishnan M, Vinod KV, Dutta TK, et al. Exploring circulatory shock and mortality in viper envenomation: a prospective observational study from India. QJM. 2018;111(11):799-806.
7. Garrahy A, Moran C, Thompson CJ. Diagnosis and management of central diabetes insipidus in adults. Clin Endocrinol (Oxf). 2019;90(1):23-30.
8. Golay V, Roychowdhary A, Pandey R, et al. Growth retardation due to panhypopituitarism and central diabetes insipidus following Russell's viper bite. Southeast Asian J Trop Med Public Health. 2013;44(4):697-702.
9. Grace M, Shanoj KC. An unusual complication of snake bite. Egypt J Intern Med. 2014;26:91-92.
10. Ghosh R, Chatterjee S, Roy D, Dubey S, Lavie CJ. Panhypopituitarism in acute myocardial infarction. Ann Afr Med. 2021;20(2):145-149.
11. Ghosh R, Roy D, Roy D, et al. A Rare Case of SARS-CoV-2 Infection Associated With Pituitary Apoplexy Without Comorbidities. J Endocr Soc. 2021;5(3):bvaa203. Published 2021 Jan 2. doi:10.1210/jendso/bvaa203
12. Bhat S, Mukhopadhyay P, Raychaudhury A, et al. Predictors of hypopituitarism due to vasculotoxic snake bite with acute kidney injury. Pituitary 2019;22(6):594-600.
13. Gupta UC, Garg OP, Kataria ML. Cranial diabetes insipidus due to viper bite. J Assoc Physicians India. 1992;40(10):686-687.
14. Krishnan MN, Kumar S, Ramamoorthy KP. Severe panhypopituitarism and central diabetes insipidus following snake bite: unusual presentation as torsades de pointes. J Assoc Physicians India. 2001; 49:923-924.
15. Shivaprasad C, Aiswarya Y, Sridevi A, et al. Delayed hypopituitarism following Russell’s viper envenomation: a case series and literature review. Pituitary. 2019;22(1):4-12.
16. White J, Alfred S, Bates D, et al. Twelve month prospective study of snakebite in a major teaching hospital in Mandalay, Myanmar; Myanmar Snakebite Project (MSP). Toxicon X. 2018;1:100002.
17. Ghosh R, León-Ruiz M, Roy D, Naga D, Sardar SS, Benito-León J. Cerebral venous sinus thrombosis following Russell's viper (Daboia russelii) envenomation: A case report and review of the literature [published online ahead of print, 2022 Aug 27]. Toxicon. 2022;218:8-12. doi:10.1016/j.toxicon.2022.08.014
18. Ghosh R, León-Ruiz M, Das S, Dubey S, Benito-León J. Snakebite envenomation-induced posterior reversible encephalopathy syndrome presenting with Bálint syndrome. Neurologia (Engl Ed). 2022 Jul 22:S2173-5808(22)00078-5. doi: 10.1016/j.nrleng.2022.06.001. Epub ahead of print. PMID: 35878800.

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