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Rey RA, Bergadá I, Ballerini MG, Braslavsky D, Chiesa A, Freire A, Grinspon RP, Keselman A, Arcari A. Diagnosing and treating anterior pituitary hormone deficiency in pediatric patients. Rev Endocr Metab Disord 2023:10.1007/s11154-023-09868-4. [PMID: 38112850 DOI: 10.1007/s11154-023-09868-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
Hypopituitarism, or the failure to secrete hormones produced by the anterior pituitary (adenohypophysis) and/or to release hormones from the posterior pituitary (neurohypophysis), can be congenital or acquired. When more than one pituitary hormone axis is impaired, the condition is known as combined pituitary hormone deficiency (CPHD). The deficiency may be primarily due to a hypothalamic or to a pituitary disorder, or concomitantly both, and has a negative impact on target organ function. This review focuses on the pathophysiology, diagnosis and management of anterior pituitary hormone deficiency in the pediatric age. Congenital hypopituitarism is generally due to genetic disorders and requires early medical attention. Exposure to toxicants or intrauterine infections should also be considered as potential etiologies. The molecular mechanisms underlying the fetal development of the hypothalamus and the pituitary are well characterized, and variants in the genes involved therein may explain the pathophysiology of congenital hypopituitarism: mutations in the genes expressed in the earliest stages are usually associated with syndromic forms whereas variants in genes involved in later stages of pituitary development result in non-syndromic forms with more specific hormone deficiencies. Tumors or lesions of the (peri)sellar region, cranial radiation therapy, traumatic brain injury and, more rarely, other inflammatory or infectious lesions represent the etiologies of acquired hypopituitarism. Hormone replacement is the general strategy, with critical periods of postnatal life requiring specific attention.
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Affiliation(s)
- Rodolfo A Rey
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, C1425EFD, Argentina.
| | - Ignacio Bergadá
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, C1425EFD, Argentina
| | - María Gabriela Ballerini
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, C1425EFD, Argentina
| | - Débora Braslavsky
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, C1425EFD, Argentina
| | - Ana Chiesa
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, C1425EFD, Argentina
| | - Analía Freire
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, C1425EFD, Argentina
| | - Romina P Grinspon
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, C1425EFD, Argentina
| | - Ana Keselman
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, C1425EFD, Argentina
| | - Andrea Arcari
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET - FEI - División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, C1425EFD, Argentina
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Alsaedi A, Kamal NM, Bakkar A, Althobaiti E, Naeem M, Kamal M. Novel Melano-Cortin-2-Receptor Gene Mutation Presenting With Infantile Cholestasis: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2022; 15:11795476221091387. [PMID: 35418791 PMCID: PMC8998368 DOI: 10.1177/11795476221091387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
Introduction: For many years, congenital panhypopituitarism has been recognized to cause infantile cholestasis. However, the isolated cortisol deficiency as a cause of cholestasis and liver failure was rarely reported. Case description: A 32-days old male infant presented to the hepatology clinic with infantile cholestasis. His initial workup revealed alanine transaminase (ALT) level of 138 U/L, aspartate transaminase level of 76 U/L, total bilirubin (T.Bil) of 103 mmol/L, direct bilirubin of (D.Bil) 83 mmol/L, gamma-glutamyl transpeptidase (GGT) level of 28 U/L with normal prothrombin time (PT) of 13 seconds. One week later, the patient developed severe bronchiolitis necessitating mechanical ventilation associated with acute liver failure and worsening cholestasis. His ALT increased to 303.5 U/L and direct bilirubin increased to 204 mmol/L with prolongation of PT to 18.9 seconds reflecting derangement in synthetic liver functions. There was associated hypoglycemia, hyponatremia and high normal potassium level with a picture of adrenal insufficiency. Hormonal workup and genetic testing revealed isolated cortisol deficiency with a novel homozygous mutation c.763_764delAT (p. Met255ValfsX17) in Melanocortin 2 receptor gene (MC2R) and the patient was diagnosed as familial primary glucocorticoid deficiency. The patient was maintained on cortisol replacement therapy with the resolution of cholestasis and normalization of liver functions. Conclusions: Patients presenting with infantile cholestasis associated with documented hypoglycemia should alert pediatricians about the possibility of familial glucocorticoid deficiency and prompt investigation of adrenal function should be considered. Cortisol replacement therapy leads to the resolution of cholestasis.
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Affiliation(s)
- Abdulaziz Alsaedi
- Consultant Pediatric Endocrinologist, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Naglaa M Kamal
- Professor of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Egypt
| | - Ayman Bakkar
- Consultant Pediatric Endocrinologist, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Enad Althobaiti
- Pediatric Endocrinology Senior Registrar, Alhada Military Hospital, Taif, Saudi Arabia
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El Qadiry R, Ouayad A, Nassih H, Bourrahouat A, Ait Sab I. Neonatal Cholestasis: A Rare and Unusual Presentation of Pituitary Stalk Interruption Syndrome. Case Rep Endocrinol 2021; 2021:6161508. [PMID: 36720102 PMCID: PMC8166483 DOI: 10.1155/2021/6161508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/18/2021] [Indexed: 02/02/2023] Open
Abstract
Pituitary stalk interruption syndrome (PSIS) is a very rare entity, and the clinical manifestations are nonspecific. Neonatal cholestasis due to endocrine disorders is rare and poorly recognized. Our case report describes a case of PSIS in a Moroccan infant revealed by isolated neonatal cholestasis, which is an unusual presentation in children. Case report. A 40-day-old girl was admitted to our department for progressive cholestatic jaundice appeared on the third day of life. She was born from a non-consanguineous marriage, and her prenatal and perinatal history went without incident. Physical examination showed icteric skin and sclera, without hepatomegaly. Analysis of pituitary hormones revealed panhypopituitarism. On brain magnetic resonance imaging (MRI), the pituitary stalk was absent, the posterior pituitary was ectopic, and the anterior pituitary was hypoplastic. The patient was diagnosed with interrupted pituitary stalk syndrome. The treatment consisted of hormone replacement with rapid improvement of her clinical condition. Conclusion. Panhypopituitarism, a consequence of PSIS, is a rare cause of neonatal cholestasis. However, pediatricians should keep this syndrome in mind for patients who present with neonatal cholestasis.
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Affiliation(s)
- R. El Qadiry
- Pediatric B Department, Mother-Child Pole, Mohammed VI University Hospital, Marrakesh, Morocco
| | - A. Ouayad
- Pediatric B Department, Mother-Child Pole, Mohammed VI University Hospital, Marrakesh, Morocco
| | - H. Nassih
- Pediatric B Department, Mother-Child Pole, Mohammed VI University Hospital, Marrakesh, Morocco
| | - A. Bourrahouat
- Pediatric B Department, Mother-Child Pole, Mohammed VI University Hospital, Marrakesh, Morocco
| | - I. Ait Sab
- Pediatric B Department, Mother-Child Pole, Mohammed VI University Hospital, Marrakesh, Morocco
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Di Dato F, Capalbo D, Mirra R, Del Vecchio Blanco F, Salerno M, Iorio R. Case Report: Neonatal Cholestasis as Early Manifestation of Primary Adrenal Insufficiency. Front Pediatr 2021; 9:767858. [PMID: 34858908 PMCID: PMC8632351 DOI: 10.3389/fped.2021.767858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Neonatal cholestasis (NC) may be due to multiple surgical and non-surgical causes, some of which are potentially fatal. The list of potential causes of NC is long, and the systematic search for each of them is challenging in infants, especially when overt signs of underlying disease are lacking. Endocrinological diseases as causes of NC are rare and sometimes misdiagnosed. We report the case of an infant with prolonged cholestatic jaundice due to adrenal insufficiency suspected because of a single episode of hypoglycemia occurring at birth in the absence of clinical signs of adrenal impairment. Clinical exome analysis identified a new homozygous variant in MC2R gene as a putative responsible for familial glucocorticoid deficiency (FGD). Adrenal insufficiency should always be considered in all cholestatic infants, even in the absence of specific symptoms, since early recognition and treatment is essential to prevent life-threatening events.
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Affiliation(s)
- Fabiola Di Dato
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Donatella Capalbo
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Rita Mirra
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Mariacarolina Salerno
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Raffaele Iorio
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
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Chugh A, Younis M, Shah K, Hart L, Hu S, Hart J, Azzam R. Hepatic Dysfunction and Hypoglycemia in a Newborn. Clin Pediatr (Phila) 2020; 59:834-836. [PMID: 32338042 DOI: 10.1177/0009922820916896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ankur Chugh
- Medical College of Wisconsin, Milwaukee, WI, USA
- Comer Children's Hospital, Chicago, IL, USA
| | | | | | - Lara Hart
- McGill University, Montreal, Quebec, Canada
| | - Shaomin Hu
- University of Chicago Medical Center, Chicago, IL, USA
| | - John Hart
- University of Chicago Medical Center, Chicago, IL, USA
| | - Ruba Azzam
- Comer Children's Hospital, Chicago, IL, USA
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Altay D, Eren E, Ozkan TB, Ozgur T, Tarım O. Liver Involvement in Congenital Hypopituitarism. Indian J Pediatr 2019; 86:412-416. [PMID: 30666560 DOI: 10.1007/s12098-018-2833-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 11/30/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cholestatic jaundice in early infancy is a complex diagnostic challenge. Cholestasis caused by endocrine disease is rare and poorly recognized. The aim of this paper is to report patients with liver dysfunctions resulting from hypopituitarism. METHODS Six patients with liver dysfunction diagnosed as hypopituitarism were studied and followed up at Uludag University Faculty of Medicine. RESULTS The median age of the patients at first presentation was 2.5 mo. Three patients were diagnosed with congenital hypopituitarism at the first visit, and the other three were diagnosed during follow-up. Serum aminotransferase levels were very high in two patients and only moderately elevated in the others. Combined adrenal, thyroid, and growth hormone deficiencies were diagnosed in two patients, while remaining 4 patients had various combinations of adrenal, thyroid, and growth hormone deficiencies. Liver function abnormalities resolved between 10 d and 2 mo follow-up after hormone replacement therapy. CONCLUSIONS Abnormal liver biochemical test results due to hormonal deficiencies in infants should be considered in the differential diagnosis by pediatricians. Hormone replacement therapy is the basis of treatment.
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Affiliation(s)
- Derya Altay
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Erciyes University Faculty of Medicine, Kayseri, Turkey.
| | - Erdal Eren
- Department of Pediatric Endocrinology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Tanju Basarır Ozkan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Taner Ozgur
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Omer Tarım
- Department of Pediatric Endocrinology, Uludag University Faculty of Medicine, Bursa, Turkey
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Gujral J, Yau M, Yang AC, Kastury R, Romero CJ, Wallach E, Wilkes M, Costin G, Rapaport R. Primary Cortisol Deficiency and Growth Hormone Deficiency in a Neonate With Hypoglycemia: Coincidence or Consequence? J Endocr Soc 2019; 3:838-846. [PMID: 30963141 PMCID: PMC6447946 DOI: 10.1210/js.2018-00386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/15/2019] [Indexed: 11/19/2022] Open
Abstract
Cortisol and growth hormone (GH) deficiencies are causes of neonatal hypoglycemia. When they coexist, a pituitary disorder is suspected. We present an infant with hypoglycemia in whom an ACTH receptor defect was associated with transient GH deficiency. A full-term boy with consanguineous parents presented with hypoglycemia (serum glucose 18 mg/dL) at 4 hours of life with undetectable serum cortisol (<1 μg/dL). Examination showed diffuse hyperpigmentation with normal male genitalia. Patient developed hyperbilirubinemia and elevated transaminase levels. GH levels of 6.8 ng/mL and 7.48 ng/mL during episodes of hypoglycemia, peak of 9.2 ng/mL with glucagon stimulation, and undetectable IGF-1 suggested GH deficiency. Thyroid function, prolactin, and gonadotropins were normal. Baseline ACTH was elevated at 4868 pg/mL, whereas serum cortisol remained undetectable with ACTH stimulation. Hydrocortisone replacement resulted in normalization of blood glucose and cholestasis with decline in ACTH level. GH therapy was not initiated, given improvement in cholestasis and euglycemia. An ACTH receptor defect was confirmed with molecular genetic testing that revealed homozygosity for a known mutation of the melanocortin 2 receptor (MC2R) gene. At 12 weeks, a random GH level was 10 ng/mL. IGF-1 was 75 ng/mL and 101 ng/mL at 7 and 9 months, respectively. This report describes glucocorticoid deficiency from an MC2R mutation associated with GH deficiency. With glucocorticoid replacement, GH secretion normalized. Our findings are consistent with a previously stated hypothesis that physiologic glucocorticoid levels may be required for optimal GH secretion [1].
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Affiliation(s)
- Jasmine Gujral
- Division of Pediatric Endocrinology and Diabetes, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mabel Yau
- Division of Pediatric Endocrinology and Diabetes, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amy C Yang
- Division of Medical Genetics, Department of Genetics and Genomic Sciences, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rama Kastury
- Division of Medical Genetics, Department of Genetics and Genomic Sciences, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher J Romero
- Division of Pediatric Endocrinology and Diabetes, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth Wallach
- Division of Pediatric Endocrinology and Diabetes, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Meredith Wilkes
- Division of Pediatric Endocrinology and Diabetes, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gertrude Costin
- Division of Pediatric Endocrinology and Diabetes, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Rapaport
- Division of Pediatric Endocrinology and Diabetes, Mount Sinai Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract
Hypopituitarism is defined as a decreased release of hypophyseal hormones, which may be caused by disease of the pituitary gland disease or hypothalamus. The clinical findings of neonatal hypopituitarism depend on the causes and on presence and extent of hormonal deficiency. Patients may be asymptomatic or may demonstrate non-specific symptoms, but may still be at risk for development of pituitary hormone deficiency over time. Patient history, physical examination, endocrinological, radiological and genetic evaluations are all important for early diagnosis and treatment. The aim of this paper was to present a review of etiological factors, clinical findings, diagnosis and treatment approaches in neonatal hypopituitarism.
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Affiliation(s)
- Selim Kurtoğlu
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatalogy, Kayseri, Turkey,Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Kayseri, Turkey
| | - Ahmet Özdemir
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatalogy, Kayseri, Turkey,* Address for Correspondence: Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatalogy, Kayseri, Turkey Phone: +90 352 207 66 66 E-mail:
| | - Nihal Hatipoğlu
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Kayseri, Turkey
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Braslavsky D, Méndez MV, Prieto L, Keselman A, Enacan R, Gruñeiro-Papendieck L, Jullien N, Savenau A, Reynaud R, Brue T, Bergadá I, Chiesa A. Pilot Neonatal Screening Program for Central Congenital Hypothyroidism: Evidence of Significant Detection. Horm Res Paediatr 2018; 88:274-280. [PMID: 28898885 DOI: 10.1159/000480293] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/13/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND/AIM Congenital hypothyroidism (CH) is a heterogeneous entity. Neonatal screening programs based on thyrotropin (TSH) determination allow primary CH diagnosis but miss central CH (CCH). CCH causes morbidity, alerts to other pituitary deficiencies, and is more prevalent than previously thought. We aimed at developing a pilot neonatal screening program for CCH detection. PATIENTS AND METHODS A prospective 2-year pilot neonatal screening study based on simultaneous dried blood specimen TSH and thyroxine (T4) measurements was implemented in term newborns aged 2-7 days. Those with T4 ≤4.5 µg/dL (-2.3 SDS) and TSH <10 mIU/L were recalled (suspicious of CCH) and underwent clinical and biochemical assessment performed by expert pediatric endocrinologists. RESULTS A total of 67,719 newborns were screened. Primary CH was confirmed in 24 (1: 2,821). Forty-four newborns with potential CCH were recalled (recall rate 0.07%) at a mean age of 12.6 ± 4.8 days. In this group, permanent CCH was confirmed in 3 (1: 22,573), starting L-T4 treatment at a mean age of 12.3 ± 6.6 days; 14 boys showed T4-binding globulin deficiency (1: 4,837); 24 had transient hypothyroxinemia (21 non-thyroidal illness and 3 healthy); and 3 died before the confirmation stage. According to initial free T4 measurements, CCH patients had moderate hypothyroidism. CONCLUSIONS Adding T4 to TSH measurements enabled the identification of CCH as a prevalent condition and contributed to improving the care of newborns with congenital hypopituitarism and recognizing other thyroidal disorders.
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Affiliation(s)
- Débora Braslavsky
- Fundación de Endocrinología Infantil, Buenos Aires, Argentina.,Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | | | - Laura Prieto
- Fundación de Endocrinología Infantil, Buenos Aires, Argentina
| | - Ana Keselman
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Rosa Enacan
- Fundación de Endocrinología Infantil, Buenos Aires, Argentina
| | | | - Nicolas Jullien
- Faculté de Médecine de Marseille, Aix-Marseille Université, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille (CRN2M), Centre National de la Recherche Scientifique, Marseille, France
| | - Alexandru Savenau
- Faculté de Médecine de Marseille, Aix-Marseille Université, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille (CRN2M), Centre National de la Recherche Scientifique, Marseille, France.,Department of Endocrinology, Hôpital de la Conception, Marseille, France.,Centre de Référence des Maladies Rares de l'Hypophyse, Hôpital de la Conception, Marseille, France.,Laboratory of Biochemistry and Molecular Biology, Hôpital de la Conception, Marseille, France
| | - Rachel Reynaud
- Faculté de Médecine de Marseille, Aix-Marseille Université, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille (CRN2M), Centre National de la Recherche Scientifique, Marseille, France.,Paediatric Endocrinology Unit, Department of Paediatrics, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Thierry Brue
- Faculté de Médecine de Marseille, Aix-Marseille Université, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille (CRN2M), Centre National de la Recherche Scientifique, Marseille, France.,Department of Endocrinology, Hôpital de la Conception, Marseille, France.,Centre de Référence des Maladies Rares de l'Hypophyse, Hôpital de la Conception, Marseille, France
| | - Ignacio Bergadá
- Fundación de Endocrinología Infantil, Buenos Aires, Argentina.,Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Ana Chiesa
- Fundación de Endocrinología Infantil, Buenos Aires, Argentina.,Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
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Ueda Y, Aoyagi H, Tajima T. A newborn with combined pituitary hormone deficiency developing shock and sludge. J Pediatr Endocrinol Metab 2017; 30:1333-1336. [PMID: 29176025 DOI: 10.1515/jpem-2017-0203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/12/2017] [Indexed: 11/15/2022]
Abstract
A male neonate was born at 41 weeks of gestation with a birth weight of 3320 g. Artificial respiratory management was required due to respiratory disturbance 1 h after birth, and subsequently catecholamine-refractory low cardiac output-induced shock occurred. Severe combined pituitary hormone deficiency (CPHD) was considered based on the presence of his respiratory disturbance, hypoglycemia and micropenis. After hydrocortisone (HDC) administration, circulatory dynamics rapidly improved. Brain magnetic resonance imaging (MRI) showed aplasia of the anterior pituitary gland and ectopic posterior gland. γ-Glutamyltranspeptidase (γ-GTP) increased from day 10 after birth and direct bilirubin increased from day 18. On ultrasonography, sludge filling the common bile duct and gall bladder was observed. After initiating treatment with both ursodeoxycholic acid and recombinant human growth hormone (rhGH), cholestasis improved and the sludge disappeared at 3 months after birth. In newborns with CPHD, severe central adrenal insufficiency might induce cardiogenic shock after birth. Early diagnosis and intervention are necessary.
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Chan U, Chan WT, Ting WH, Ho CS, Liu HC, Lee HC. Cholestasis caused by panhypopituitarism and acquired cytomegalovirus infection in a 2-month-old male infant: A case report. Medicine (Baltimore) 2017; 96:e6757. [PMID: 28445302 PMCID: PMC5413267 DOI: 10.1097/md.0000000000006757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Septo-optic dysplasia (SOD) is a rare congenital disorder that may cause jaundice in infants. However, it is usually prone to neglect and misdiagnosis in infants with cholestasis because endocrine disorder such as panhypopituitarism is rare in the cause of infantile cholestasis. We report a case of SOD concurrent with acquired cytomegalovirus (CMV) infection, who presented with prolonged jaundice as the first clinical sign. PATIENT CONCERNS The patient was a 2-month-old male infant who presented with cholestasis, combined with fever and panhypopituitarism. DIAGNOSES He was diagnosed with SOD and acquired CMV infection. INTERVENTIONS He was treated with hormone replacement therapy and ganciclovir. OUTCOMES After correction of the pituitary hormone deficiency and ganciclovir treatment, significant improvements of cholestasis, retinal lesions, and growth rate were seen in our patient. LESSONS Although an endocrine disorder such as panhypopituitarism is rare in the cause of neonatal or infantile cholestasis, we must keep this reason in mind.
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Affiliation(s)
- U Chan
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Wai-Tao Chan
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Wei-Hsin Ting
- Division of Endocrinology and Metabolism, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Che-Sheng Ho
- Division of Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Hsi-Che Liu
- Division of Hematology-Oncology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
- MacKay Medical College, Taipei, Taiwan
| | - Hung-Chang Lee
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
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Braslavsky D, Grinspon RP, Ballerini MG, Bedecarrás P, Loreti N, Bastida G, Ropelato MG, Keselman A, Campo S, Rey RA, Bergadá I. Hypogonadotropic Hypogonadism in Infants with Congenital Hypopituitarism: A Challenge to Diagnose at an Early Stage. Horm Res Paediatr 2016; 84:289-97. [PMID: 26355950 DOI: 10.1159/000439051] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/27/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Combined pituitary hormone deficiency (CPHD) presents a wide spectrum of pituitary gland disorders. The postnatal gonadotropic surge provides a useful period to explore the gonadotropic axis for assessing the presence of congenital hypogonadotropic hypogonadism (CHH). AIM To explore the functioning of the hypothalamic-pituitary-gonadal axis in the postnatal gonadotropic surge for an early diagnosis of CHH in newborns or infants suspected of having CPHD. SUBJECTS AND METHODS A cohort of 27 boys under 6 months and 19 girls under 24 months of age with suspected hypopituitarism was studied. Serum concentrations of LH, FSH, testosterone, inhibin B, anti-Müllerian hormone (AMH) and estradiol were measured, and male external genitalia were characterized as normal or abnormal (micropenis, microorchidism and/or cryptorchidism). RESULTS CPHD was confirmed in 36 out of 46 patients. Low LH and testosterone levels were found in 66% of the hypopituitary males, in significant association with the presence of abnormal external genitalia. This abnormality had a positive predictive value of 93% for CHH. No significant association was observed between serum FSH, AMH and inhibin B and the patient's external genitalia. CONCLUSION In newborn or infant boys with CPHD, LH and testosterone concentrations measured throughout the postnatal gonadotropic surge, together with a detailed evaluation of the external genital phenotype, facilitate the diagnosis of CHH at an early stage.
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Affiliation(s)
- Débora Braslavsky
- Centro de Investigaciones Endocrinolx00F3;gicas x2018;Dr. Cx00E9;sar Bergadx00E1;' (CEDIE), Divisix00F3;n de Endocrinologx00ED;a, Hospital de Nix00F1;os Ricardo Gutix00E9;rrez, Buenos Aires, Argentina
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Mauvais FX, Gonzales E, Davit-Spraul A, Jacquemin E, Brauner R. Cholestasis Reveals Severe Cortisol Deficiency in Neonatal Pituitary Stalk Interruption Syndrome. PLoS One 2016; 11:e0147750. [PMID: 26829045 PMCID: PMC4735111 DOI: 10.1371/journal.pone.0147750] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/06/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Cholestasis has been reported during the course of congenital hypothalamic-pituitary deficiency, but crucial information is lacking regarding both its origin and prognosis. We aimed to characterize the course of cholestasis and factors contributing to it in patients with deficiency due to pituitary stalk interruption syndrome (PSIS). METHODS We conducted a retrospective single-center, case-cohort study including 16 patients with PSIS diagnosed before one year of age. We collected clinical and biological parameters from medical records and compared the characteristics of the endocrine syndrome in PSIS patients with and without cholestasis. RESULTS 5/16 patients had cholestasis, all with a neonatal onset and multiple hypothalamic-pituitary deficiency. Patients with cholestasis presented with lower Apgar score and higher rate of ophthalmic malformations: 3/5 vs 1/11, p = 0.03 and 5/5 vs 4/11, p = 0.02, respectively. The plasma cortisol level was strongly decreased in patients with cholestasis: 12.4 ng/mL (8-15 ng/mL) vs 79.4 ng/mL (10-210 ng/mL), p = 0.04. Cholestasis resolved within 9 months following hormone supplementation. No development of chronic liver disease was observed during a median follow-up of 9.4 years (range, 1.3-13.3 years). CONCLUSIONS Cholestasis is a frequent symptom at presentation of PSIS during the neonatal period that may help earlier diagnosis and that indicates a profound cortisol deficiency.
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Affiliation(s)
- Francois-Xavier Mauvais
- Pediatric Hepatology and Liver Transplantation Unit, Reference centre for pediatric liver diseases–DHU Hepatinov, Hôpital Bicêtre, Assistance Publique—Hôpitaux de Paris, Le Kremlin Bicêtre, France
- Institut National de la Santé et de la Recherche Médicale Unité 1151 et Centre National de la Recherche Scientifique, UMR8253, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France
| | - Emmanuel Gonzales
- Pediatric Hepatology and Liver Transplantation Unit, Reference centre for pediatric liver diseases–DHU Hepatinov, Hôpital Bicêtre, Assistance Publique—Hôpitaux de Paris, Le Kremlin Bicêtre, France
- Institut National de la Santé et de la Recherche Médicale UMR-S 1174, Orsay, France
- Université Paris-Sud 11, Faculté de médecine, Le Kremlin Bicêtre, France
| | - Anne Davit-Spraul
- Biochemistry laboratory, Hôpital Bicêtre, Assistance Publique—Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Emmanuel Jacquemin
- Pediatric Hepatology and Liver Transplantation Unit, Reference centre for pediatric liver diseases–DHU Hepatinov, Hôpital Bicêtre, Assistance Publique—Hôpitaux de Paris, Le Kremlin Bicêtre, France
- Institut National de la Santé et de la Recherche Médicale UMR-S 1174, Orsay, France
- Université Paris-Sud 11, Faculté de médecine, Le Kremlin Bicêtre, France
| | - Raja Brauner
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France
- Pediatric Endocrinology Unit, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
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Cavarzere P, Biban P, Gaudino R, Perlini S, Sartore L, Chini L, Silvagni D, Antoniazzi F. Diagnostic pitfalls in the assessment of congenital hypopituitarism. J Endocrinol Invest 2014; 37:1201-9. [PMID: 25080869 DOI: 10.1007/s40618-014-0139-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/12/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The diagnosis of congenital hypopituitarism is difficult and often delayed because its symptoms are nonspecific. AIM To describe the different clinical presentations of children with congenital hypopituitarism to reduce the time for diagnosis and to begin a precocious and appropriate treatment. STUDY DESIGN We analyzed a cohort of five children with congenital hypopituitarism, describing their clinical, biochemical and radiological characteristics from the birth to diagnosis. RESULTS As first sign of the disease, all of five patients presented a neonatal hypoglycemia, associated in four cases with jaundice. In all these four cases, the clinicians hypothesized a metabolic disease delaying the diagnosis, which was performed in only two cases within the neonatal period. In the other three cases, the diagnosis was formulated at 2, 5 and 8 years of life because there was severe and precocious growth impairment. CONCLUSIONS It is important to suspect congenital hypopituitarism in the presence of persistent neonatal hypoglycemia associated with jaundice and of a precocious and severe reduction of the growth velocity in childhood. In all these cases, it is necessary to undertake a hypothalamic-pituitary magnetic resonance imaging scan as soon as possible, and to start appropriate treatment.
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Affiliation(s)
- Paolo Cavarzere
- Pediatric Division, Department of Pediatrics, Universitary Hospital of Verona, Piazzale Stefani 1, 37126, Verona, Italy,
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