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Benvenga S, Klose M, Vita R, Feldt-Rasmussen U. Less known aspects of central hypothyroidism: Part 1 - Acquired etiologies. J Clin Transl Endocrinol 2018; 14:25-33. [PMID: 30416972 PMCID: PMC6205405 DOI: 10.1016/j.jcte.2018.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 12/24/2022] Open
Abstract
Central hypothyroidism (CH) is a rare cause of hypothyroidism. CH is frequently overlooked, as its clinical picture is subtle and includes non-specific symptoms; furthermore, if measurement of TSH alone is used to screen for thyroid function, TSH concentrations can be normal or even above the upper normal reference limit. Indeed, certain patients are at risk of developing CH, such as those with a pituitary adenoma or hypophysitis, those who have been treated for a childhood malignancy, have suffered a head trauma, sub-arachnoid hemorrhage or meningitis, and those who are on drugs capable to reduce TSH secretion.
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Key Words
- ADH, antidiuretic hormone
- AT/RT, atypical teratoid/rhabdoid tumor
- CH, central hypothyroidism
- CNS, central nervous system
- CPI, conformal primary-site irradiation
- CRI, cranial irradiation
- Central hypothyroidism
- Congenital hypothyroidism
- DDMS, Dyke-Davidoff-Masson syndrome
- FSH, follicle-stimulating hormone
- FT3, free triiodothyronine
- FT4, free thyroxine
- GCT, germ cell tumor
- GH, growth hormone
- Hypopituitarism
- IGF-1, insulin growth factor-1
- LH, luteinizing hormone
- MB, medulloblastoma
- PD-1, programmed cell death-1 receptor
- PNET, primitive neuroectodermal tumor
- PRL, prolactin
- SAH, subarachnoid hemorrhage
- TBI, traumatic brain injury
- TRH, TSH-releasing hormone
- TSH, thyrotropin
- Thyrotropin deficiency
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Affiliation(s)
- Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Master Program on Childhood, Adolescent and Women’s Endocrine Health, University of Messina, Messina, Italy
- Interdepartmental Program of Molecular & Clinical Endocrinology, and Women’s Endocrine Health, University Hospital Policlinico G. Martino, Messina, Italy
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Roberto Vita
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Copenhagen, Denmark
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2
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Abstract
Mutations of growth hormone genes and pituitary transcription factors account for a small proportion of cases of severe congenital hypopituitarism. Most cases show characteristic MRI findings of pituitary stalk interruption syndrome. Clinical suspicion should prompt assessment of cortisol, free T4, thyroid-stimulating hormone, and growth hormone levels together with MRI of the hypothalamic and pituitary regions.
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Affiliation(s)
- John S Parks
- Emory University School of Medicine, Atlanta, GA 30322, USA.
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3
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Lee H, Lee SW, Shim SY, Park EA, Cho SJ. Neonatal Group B Streptococcal Meningitis Complicated with Secondary Hypopituitarism: A Case Report. NEONATAL MEDICINE 2016. [DOI: 10.5385/nm.2016.23.4.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Hyunju Lee
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sang Won Lee
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - So Yeon Shim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eun Ae Park
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Su Jin Cho
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
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Ferreira AS, Fernandes ALLA, Guaragna-Filho G. Hypopituitarism as consequence of late neonatal infection by Group B streptococcus: a case report. Pan Afr Med J 2015; 20:308. [PMID: 26161231 PMCID: PMC4489941 DOI: 10.11604/pamj.2015.20.308.6538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/26/2015] [Indexed: 11/11/2022] Open
Abstract
Hypopituitarism is a condition characterized by dysfunction of the pituitary gland hormone production. The insults of the perinatal period, which includes the late infection by Group B Streptococcus, consists in a rare etiology of this condition. We present the case of a 39-days-old infant with meningitis caused by Streptococcus Group B, which showed, among other consequences, hypopituitarism.
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Affiliation(s)
- Amanda Santana Ferreira
- Pediatric Emergency Unit, Complexo Hospitalar Prefeito Edivaldo Orsi (Ouro Verde), Campinas, São Paulo, Brazil
| | | | - Guilherme Guaragna-Filho
- Pediatric Endocrinologist, Pediatric Emergency Unit, Complexo Hospitalar Prefeito Edivaldo Orsi (Ouro Verde), Campinas, São Paulo, Brazil
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Levy-Shraga Y, Gazit I, Modan-Moses D, Pinhas-Hamiel O. Pituitary function in children following infectious diseases of the central nervous system. Pituitary 2014; 17:118-24. [PMID: 23471654 DOI: 10.1007/s11102-013-0476-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recent studies in adults suggest that pituitary deficiencies develop in a considerable proportion of patients who recover from infectious meningitis. The aim of this study was to evaluate pituitary function of children with a history of meningitis. Seventy-nine children were admitted to the Safra Children's Hospital due to meningitis between 2007 and 2010. Twenty-four families were lost for follow-up, 55 were interviewed by phone and 14 (9 males) participated in the study. Evaluation included medical history, physical examination, auxological measurements and basal levels of TSH, fT4, cortisol and IGF1. Children with abnormal results were followed for a year and dynamic testing was performed when indicated. Mean age at time of infectious meningitis was 3.8 ± 5.4 years (range 0.03-15.8), and at clinical evaluation 6.4 ± 6.4 (range 1.2-20). The interval between the acute event and evaluation was 2.7 ± 1.2 years. Thyroid function tests and basal cortisol levels were normal for all children. Three children had low IGF1 levels; however over a year of follow-up two of them had normal height and growth velocity, making growth hormone deficiency unlikely. One child had low height SDS, but exhibited a normal response to a growth hormone stimulation test. Pituitary dysfunction with overt clinical symptoms is not a frequent consequence of acute meningitis in children. Follow-up of growth and puberty of children post-meningitis by the primary care physician is probably sufficient. Invasive assessments should be reserved for selected cases where there is slow growth or other clinical suspicion of hypopituitarism.
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Affiliation(s)
- Yael Levy-Shraga
- Pediatric Endocrine and Diabetes Unit, Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel,
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6
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Tanriverdi F, De Bellis A, Teksahin H, Alp E, Bizzarro A, Sinisi AA, Bellastella G, Paglionico VA, Bellastella A, Unluhizarci K, Doganay M, Kelestimur F. Prospective investigation of pituitary functions in patients with acute infectious meningitis: is acute meningitis induced pituitary dysfunction associated with autoimmunity? Pituitary 2012; 15:579-88. [PMID: 22228382 DOI: 10.1007/s11102-011-0371-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Previous case reports and retrospective studies suggest that pituitary dysfunction may occur after acute bacterial or viral meningitis. In this prospective study we assessed the pituitary functions, lipid profile and anthropometric measures in adults with acute bacterial or viral meningitis. Moreover, in order to investigate whether autoimmune mechanisms could play a role in the pathogenesis of acute meningitis-induced hypopituitarism we also investigated the anti-pituitary antibodies (APA) and anti-hypothalamus antibodies (AHA) prospectively. Sixteen patients (10 males, 6 females; mean ± SD age 40.9 ± 15.9) with acute infectious meningitis were included and the patients were evaluated in the acute phase, and at 6 and 12 months after the acute meningitis. In the acute phase 18.7% of the patients had GH deficiency, 12.5% had ACTH and FSH/LH deficiencies. At 12 months after acute meningitis 6 of 14 patients (42.8%) had GH deficiency, 1 of 14 patients (7.1%) had ACTH and FSH/LH deficiencies. Two of 14 patients (14.3%) had combined hormone deficiencies and four patients (28.6%) had isolated hormone deficiencies at 12 months. Four of 9 (44.4%) hormone deficiencies at 6 months were recovered at 12 months, and 3 of 8 (37.5%) hormone deficiencies at 12 months were new-onset hormone deficiencies. At 12 months there were significant negative correlations between IGF-I level vs. LDL-C, and IGF-I level vs. total cholesterol. The frequency of AHA and APA positivity was substantially high, ranging from 35 to 50% of the patients throughout the 12 months period. However there were no significant correlations between AHA or APA positivity and hypopituitarism. The risk of hypopituitarism, GH deficiency in particular, is substantially high in the acute phase, after 6 and 12 months of the acute infectious meningitis. Moreover we found that 6th month after meningitis is too early to make a decision for pituitary dysfunction and these patients should be screened for at least 12 months. In addition, the occurrence of AHA and APA positivity due to acute infectious meningitis was demonstrated for the first time. Further longer-term prospective investigations need to be carried out on a larger cohort of patients to understand the role of autoimmunity in the pathogenesis of late hypopituitarism after acute infectious meningitis.
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Affiliation(s)
- F Tanriverdi
- Department of Endocrinology, Erciyes University Medical School, 38039 Kayseri, Turkey
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7
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Complication rare d’une méningite néonatale à Streptocoque B : le diabète insipide central. Arch Pediatr 2011; 18:1112-3. [DOI: 10.1016/j.arcped.2011.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 07/21/2011] [Indexed: 11/23/2022]
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8
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Hägg E, Aström L, Steen L. Persistent hypothalamic-pituitary insufficiency following acute meningoencephalitis. A report of two cases. ACTA MEDICA SCANDINAVICA 2009; 203:231-5. [PMID: 636918 DOI: 10.1111/j.0954-6820.1978.tb14862.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This report concerns two patients, a 43-year-old woman and a 53-year-old man, who developed clinical as well as laboratory signs of permanent gonodal and thyroid failure following an acute intracranial infection--in the woman a meningoencephalitis of unknown origin, and in the man an encephalitis caused by Coxsackie B5. Endocrine investigations were compatible with hypothalamic-pituitary dysfunction, with some of the results favoring a hypothalamic lesion. Perhaps hormone deficiency of hypothalamic and/or pituitary origin is a more common sequel of acute meningoencephalitis than has hitherto been reported.
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Tanriverdi F, Alp E, Demiraslan H, Dokmetas HS, Unluhizarci K, Doganay M, Casanueva FF, Kelestimur F. Investigation of pituitary functions in patients with acute meningitis: a pilot study. J Endocrinol Invest 2008; 31:489-91. [PMID: 18591878 DOI: 10.1007/bf03346395] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Although long-term pituitary consequences of tuberculous meningitis are well documented in the literature, there have been few case reports of pituitary dysfunction after acute bacterial or viral meningitis. In this preliminary study, we have assessed the pituitary functions in adult patients who had acute bacterial or viral meningitis. DESIGN AND METHODS Fourteen patients (8 men, 6 women; mean age 35.3+/-13.3) were included in the study. The diagnosis of bacterial and viral meningitis was proven by clinical findings, cerebrospinal fluid (CSF) examination, gram staining, and blood and CSF cultures. Pituitary functions were evaluated ranging from 6 to 48 months (mean 20 months) after acute meningitis. GH deficiency was investigated by the GHRH+arginine stimulation test. RESULTS Four of 14 patients (28.6%) had isolated GH deficiency. In GH-deficient patients, the earliest duration was 6 months and the latest duration was 48 months after the diagnosis of acute meningitis. Three of the GH-deficient patients had acute bacterial meningitis and 1 patient had acute viral meningitis. Pituitary magnetic resonance imaging revealed normal pituitary gland in the patients with GH deficiency. CONCLUSIONS This is the first systematic study evaluating the anterior pituitary function long term after the diagnosis of acute meningitis. Based on the present study, it is tempting to speculate that pituitary dysfunction is a more common sequel of acute bacterial or viral meningitis than hitherto reported. Studies with high numbers of patients are warranted to ascertain the prevalence of meningitis-induced hypopituitarism.
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Affiliation(s)
- F Tanriverdi
- Department of Endocrinology, Erciyes University Medical School, 38039, Kayseri, Turkey
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10
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Quetin F, Garnier H, Brauner R, Vodovar M, Magny JF. Diabète insipide central idiopathique chez un très grand prématuré. Arch Pediatr 2007; 14:1321-3. [DOI: 10.1016/j.arcped.2007.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 07/09/2007] [Indexed: 10/22/2022]
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Jones M, Drut R, Valencia M, Mijalovsky A. Empty sella syndrome, panhypopituitarism, and diabetes insipidus. Fetal Pediatr Pathol 2005; 24:191-204. [PMID: 16338880 DOI: 10.1080/15227950500305843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We present an 18-month-old girl with short stature, obesity, panhypopituitarism, diabetes insipidus, and visual defects. Postmortem examination revealed brain atrophy due to a diffuse encephalopathy, numerous calcified neurons in cerebral cortex, deep telencephalic and diencephalic nuclei, diffuse neuronal necrosis in hypothalamic nuclei, moderate atrophy of optic nerves, very thin hypophyseal stalk, and empty sella with the hypophysis compressed to the dorsal aspect of the concavity. Our hypothesis is that the presence of an empty sella in a child with hypophyseal-hypothalamic abnormalities should alert physicians to the existence of hypothalamic lesions secondary to a perinatal insult. We discuss the possible pathogenesis of these findings as well as lines of evidence available in the literature.
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Affiliation(s)
- Marta Jones
- Department of Pathology, Children's Hospital Superiora Sor María Ludovica, Buenos Aires, Argentina.
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12
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Krebs VL, Damiani D, Diniz MDA, Ceccon ME, Yoshimoto C, Aguiar IF, Setian N, Ramos JL, Vaz FA. Central diabetes insipidus as a complication of neonatal pathology: report of three cases. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1998; 40:146-9. [PMID: 9581306 DOI: 10.1111/j.1442-200x.1998.tb01900.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Three patients, 11, 17 and 41 days old with various degrees of central nervous system (CNS) lesions developed central diabetes insipidus as a complication of hypothalamic damage. Two of the children had congenital CNS malformations including meningomyelocele, hydrocephalus, and prosencephaly, while the third child presented Streptococcus agalactiae meningitis, complicated with CNS hemorrhage and hypertensive dilatation of the lateral ventricles. All of them fulfilled the criteria for central diabetes insipidus, reaching high levels of serum sodium and osmolality, along with hypotonic urine. The responses to intranasal arginine-vasopressin were prompt, normalizing the serum levels of sodium and increasing urinary osmolality, allowing a better metabolic balance, avoiding continuing damage to the already compromised CNS. The neonatologist must be aware of the possibility of this kind of complication even in a normal child with CNS infection. Imaging studies showing hemorrhage in the region of the posterior hypothalamus must be a sign that this type of complication is able to occur.
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Affiliation(s)
- V L Krebs
- Neonatal Intensive Care Unit, Instituto da Criança, São Paulo University School of Medicine, Brasil
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13
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Ng PC, Lee CH, Fok TF, Lam ST, Chan YL, Wong W, Cheung KL, Chan WK. Central diabetes insipidus in a newborn with deletion of chromosome 7q. J Paediatr Child Health 1997; 33:343-5. [PMID: 9323625 DOI: 10.1111/j.1440-1754.1997.tb01613.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report an infant with midline craniofacial defects and holoprosencephaly due to chromosome 46, XY, del (7) (pter-->q34) who presented at 1 week of age with central diabetes insipidus. The importance of hypothalamic-pituitary endocrine investigation in patients with this syndrome, and more generally, in patients with midline craniofacial malformation or holoprosencephaly is emphasized. As infants with chromosome 7q deletion bear close phenotypic resemblance to infants of Trisomy 13, chromosomal confirmation and karyotype banding is mandatory to establish an accurate diagnosis and for genetic counselling of their parents.
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Affiliation(s)
- P C Ng
- Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
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Tucci M, Lebel MH, Gauthier M, Farrell CA, Lacroix J. Admission to a Pediatric Intensive Care Unit for Bacterial Meningitis: Review of 168 Cases. J Intensive Care Med 1995. [DOI: 10.1177/088506669501000508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We performed a retrospective analysis of the charts of 168 patients (1 week to 17 years of age) admitted to a pediatric intensive care unit (PICU) with bacterial meningitis over an 11-year period (1980–1990) to delineate clinical characteristics and outcome. The four major reasons for PICU admission were an altered level of consciousness (70%), hemodynamic instability (33%), seizures (13%), and apnea (7%). Many children had more than one reason for admission to the PICU. The pathogens identified included Haemophilus influenzae type b in 71 (42%) patients, Neisseria meningitidis in 33 (20%), Streptococcus pneumoniae (SP) in 23 (14%), Group B Streptococcus (GBS) in 18 (11%), Escherichia coli in 7 (4%), and others in 7 (4%). Overall mortality was 13% (22 of 168); most deaths (12/22) occurred within 24 hours of admission. The highest mortality rate was associated with GBS meningitis (39%). Average duration of stay in the PICU was 2.9 days. Complications in the PICU included seizures (32%), hemodynamic instability (23%), hyponatremia (21%), syndrome of inappropriate antidiuretic hormone secretion (13%), disseminated intravascular coagulation (12%), and hypernatremia (6%). Ninety-five percent (138/146) of the survivors were evaluated between 1 month and 1 year after discharge: 79% had no significant neurological sequelae, 14% had mild sequelae, and 7% remained with major neurological sequelae. Moderate or severe hearing deficits were detected in 13% of those evaluated (13 of 102). Patients with SP and GBS meningitis had the highest incidence of complications, sequelae, and mortality. The majority of deaths due to bacterial meningitis, in a PICU, occur early, seem unavoidable, and result from neurological or hemodynamic dysfunction. The fact that the majority of survivors have a normal outcome despite a complicated course favors provision of close surveillance and aggressive management in a PICU setting.
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Affiliation(s)
- Marisa Tucci
- From the Divisions of Intensive Care and Infectious Diseases, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, Canada
| | - Marc H. Lebel
- From the Divisions of Intensive Care and Infectious Diseases, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, Canada
| | - Marie Gauthier
- From the Divisions of Intensive Care and Infectious Diseases, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, Canada
| | - Catherine A. Farrell
- From the Divisions of Intensive Care and Infectious Diseases, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, Canada
| | - Jacques Lacroix
- From the Divisions of Intensive Care and Infectious Diseases, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, Canada
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Abstract
We report an infant who developed cranial diabetes insipidus after septicaemic shock. This condition should be considered in any child who suffers an acute collapse and it may be more common in the high risk neonate than has previously been recognised.
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Affiliation(s)
- H R Jenkins
- Department of Child Health, University of Wales College of Medicine, Cardiff
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16
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Christensen C, Bank A. Meningococcal meningitis and diabetes insipidus. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1988; 20:341-3. [PMID: 3406674 DOI: 10.3109/00365548809032462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A 20-year-old woman with a transient diabetes insipidus as a complication to meningococcal meningitis is presented. This condition has only been described once before. Culture of blood and spinal fluid yielded Neisseria meningitidis group B, sensitive to penicillin. The diabetes insipidus arose on day 4 after admission and continued to day 15. Treatment comprised benzylpenicillin, DIC therapy, assisted ventilation, and vasopressin.
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Affiliation(s)
- C Christensen
- Department of Medicine, Kolding City Hospital, Denmark
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17
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Lichtenstein MJ, Tilley WS, Sandler MP. The syndrome of hypothalamic hypopituitarism complicating viral meningoencephalitis. J Endocrinol Invest 1982; 5:111-5. [PMID: 7096919 DOI: 10.1007/bf03350501] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Diffuse hypothalamic-hypopituitarism complicating viral meningoencephalitis has been rarely documented. In this report, we describe the syndrome in a 41 yr old male and review the literature. Detailed endocrine studies were performed 1 month after the onset of apparent viral encephalitis. Repeated 08:00 h serum cortisol levels were low, but increased after administration of lysine-vasopressin. Urine 17-hydroxy-corticosteroid (17-OHCS) values rose with prolonged cortrosyn infusion, but failed to respond after administration of metyrapone. Serum thyroxine was decreased; basal levels of serum thyrotropin were low-normal, but there was a prolonged response to tyrotropin (TSH) to thyrotropin releasing hormone (TRH). Basal prolactin was elevated with a minimal response after TRH. Testosterone and gonadotropins were both diminished, and gonadotropins increased (but less than in normal subjects) after injection of gonadotropin releasing hormone (LHRH). The overnight water deprivation test confirmed the presence of diabetes insipidus. In the present context, the abnormal endocrine investigations were strongly supportive of disturbed hypothalamic activity. Hypothalamic-hypopituitarism following viral meningoencephalitis may occur more frequently than previously reported, and thus basal pituitary function should be assessed in all patients with viral meningoencephalitis.
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18
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Marilus R, Barkan A, Leiba S, Arie R, Blum I. Pyrexia of unknown origin. Presenting sign of hypothalamic hypopituitarism. Postgrad Med J 1981; 57:310-3. [PMID: 7301672 PMCID: PMC2424913 DOI: 10.1136/pgmj.57.667.310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A 62-year-old man was admitted to hospital 10 times over 12 years because of pyrexia of unknown origin. Hypothalamic hypopituitarism was diagnosed by dynamic tests including clomiphene, LRH, TRH and chlorpromazine stimulation. Lack of ACTH was demonstrated by long and short tetracosactrin tests. The aetiology of the disorder was believed to be previous encephalitis. Following substitution therapy with adrenal and gonadal steroids there were no further episodes of fever.
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Yu VY, Werther GA. Treatment of neonatal diabetes insipidus with desmopressin (DDAVP). AUSTRALIAN PAEDIATRIC JOURNAL 1980; 16:284-6. [PMID: 7016107 DOI: 10.1111/j.1440-1754.1980.tb01317.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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20
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Abstract
Vasopressin concentrations were measured in the cord blood of thirty infants, thirteen delivered vaginally and seventeen by Caesarean section. There was no correlation with maternal values but the concentration following vaginal delivery (13.5 microunits/ml +/- 7.9 SD) was significantly higher than that following Caesarean section (4.2 microunits/ml +/- 6.6 SD). Gestational age did not affect the concentrations, which fell during the first week of life and then rose gradually in term and pre-term infants. High levels were found in seven sick babies. There was no correlation in the first 3 weeks of life between plasma vasopressin and plasma or urine osmolality in well and sick babies.
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