Liver dysfunction associated with congenital hypopituitarism

Congenital hypopituitarism associated with hyperammonemia

Neonatal onset hypopituitarism is a life threatening but potentially treatable metabolic condition. However, in the majority of cases it can be fatal due to the metabolic disturbances. We report a newborn with profound symptomatic hypoglycemia and hyperammonemia who initially was thought to have an inborn error of metabolism (IEM). After an initial falsely reassuring magnetic resonance imaging (MRI) brain scan, further endocrine investigation eventually led to the correct diagnosis and treatment.

Optic nerve hypoplasia and growth hormone deficiency in a cholestatic infant

This report describes a 4-month-old male with cholestasis, hypoglycemia, and short stature. Symptoms appeared since neonatal age with jaundice, hypoglycemia, neurologic manifestations, and later with short stature. Laboratory investigation was indicative for cholestasis. Further research indicated isolated growth hormone deficiency with accompanying optic nerve hypoplasia. Unexplained hypoglycemia and cholestasis in neonates have to be investigated for growth hormone deficiency. Moreover, in cases with unexplained cholestasis, timely recognition of hypoglycemia is important for the early diagnosis of the disorder before the appearance of growth retardation.

Congenital adenohypophysis aplasia: clinical features and analysis of the transcriptional factors for embryonic pituitary development

Anterior pituitary agenesis (APA) has very rarely been reported. Therefore, its phenotypical and genotypical features are not well known. The aim of this study was to ascertain whether the clinical picture in 4 subjects with APA and multiple pituitary hormone deficiencies (MPHD) was different compared to the one observed in a selected control group consisting of 7 MPHD individuals with hypoplastic (and not aplastic) adenohypophysis and pituitary stalk interruption syndrome. Another goal was to investigate genetic basis of APA by analyzing for the first time in this condition many of the transcriptional factors which are required for both structural development and cellular differentiation of hypophysis. Age at diagnosis was significantly lower in APA children than in controls (1.5+/-2.3 vs 11.1+/-7.6 yr, p<0.0005). Microphallus and neonatal cholestasis were observed only in APA subjects (chi-squared=4.3, p<0.05) and also neonatal hypoglycemia was more frequent in APA patients than in controls (X2=4.05, p<0.05). Molecular analyses of the genes of the transcriptional factors POU1F1, PROP1, LHX3, LHX4, ISL1 and HESX1 detected no mutations in APA patients.

CONCLUSIONS

a) if compared with a selected cohort of MPHD patients with both adenohypophysis hypoplasia and pituitary stalk interruption syndrome, the ones with APA show an earlier and more severe picture of hypopituitarism; b) mutations in several transcription factors that are known to be essential for the development of Rathke's pouch are not necessarily found in humans with APA.