Hypopituitarism in a Neonate with Hyperbilirubinemia and Decreased Level of Consciousness: A Case Report Study

  • Hadi Mousavi Department of Pediatrics, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran.
  • Salar Bakhtiyari Mail Department of Clinical Biochemistry, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran.
Keywords:
Consciousness, Hyperbilirubinemia, Hypopituitarism

Abstract

Decreased level of consciousness in neonates may result from different etiologies, including rare metabolic and hormonal disorder due to anterior pituitary insufficiency. In this case report, a five-day-old newborn boy was referred to the neonatal intensive care unit of Mustafa Khomeini hospital of Ilam, Iran. He had an open anterior fontanel with no history of prenatal and familial diseases. Clinical examination showed decreased level of consciousness so that this patient responded only to painful stimuli. Furthermore, unconsciousness, hyperbilirubinemia, and hypotonia were fully evident. Given the clinical findings and decreased level of consciousness, hormonal diagnostic tests and brain CT scan were performed for any evidence of hypopituitarism. Clinical and experimental findings were consistent with the generalized edema and pituitary insufficiency secondary to central hypothyroidism and cortisol deficiency. Based on the findings, the neonate was put on the hormonal replacement therapy and, as the result, all of the abnormal clinical symptoms disappeared. In conclusion, fatal neonatal diseases may be mistaken with unimportant clinical findings at the first examination. Therefore, comprehensive attention to all potential causes of such symptoms in the neonates should be given for early diagnosis and treatment, and to prevent any fatal and irreversible complications.

References

Angel MJ, Chen R, Bryan Young G. Metabolic encephalopathies. Handb Clin Neurol 2008;90:115-66.

Wong RJ, DeSandre GH, Sibley E, Stevenson DK. Neonatal jaundice and liver disease. In: Martin RJ, Klaus MH, Fanaroff AA, Walsh MC, editors. Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 8th edition. Philadelphia: Mosby and Elsevier Press; 2006. p.1446-72.

Palma Sisto PA. Endocrine disorders in the neonate. Pediatr Clin North Am 2004;51(4):1141-68.

Toogood AA, Stewarat PM. Hypopituitarism: clinical features, diagnosis, and management. Endocrinol Metab Clin North Am 2008;37(1):235-61.

Scommegna S, Galeazzi D, Picone S, Farinelli E, Agostino R, Bozzao A, Boscherini B, Cianfarani S. Neonatal identification of pituitary aplasia: a life-saving diagnosis. Review of five cases. Horm Res 2004;62(1):10-6.

Drop SL, Colle E, Guyda HJ. Hyperbilirubinemia and idiopathic hypopituitarism in the newborn period. Acta Paediatr Scand 1979;68(2):277-80.

Drop SL, Colle E, Guyda HJ. Hyperbilirubinemia and idiopathic hypopituitarism in the newborn period. Acta Paediatr Scand 1979;68:277-80.

Haagen M, Akkurt I, Blunck W. Hypoglycemia and cholestatic jaundice in congenital panhypopituitarism.Monatsschr Kinderheilkd 1989;137(10):678-80.

Scott R, Aladangady N, Maalouf E. Neonatal hypopituitarism presenting with poor feeding, hypoglycemia and prolonged unconjugated hyperbilirubinemia. J Matern Fetal Neonatal Med 2004;16(2):131-3.

How to Cite
1.
Mousavi H, Bakhtiyari S. Hypopituitarism in a Neonate with Hyperbilirubinemia and Decreased Level of Consciousness: A Case Report Study. Acta Med Iran. 52(1):82-84.
Section
Articles