HYPOTHALAMIC PITUITARY AXIS DYSFUNCTION IN A SEVERELY ASPHYXIATED NEONATE.

Abstract

Introduction: Perinatal asphyxia is caused by a lack of oxygen to organ systems due to hypoxic or ischemic insult that occurs during labour and delivery. This may lead to multi-organ failure with brain involvement as the major organ of concern.

Case report: We present a 19-day-old neonate referred to our centre with the complaint of inability to suck since birth and multiple seizures that started on the second day of life. He cried little, slept much, and had subnormal body temperature He was delivered via spontaneous vertex delivery at 41 weeks to a 19-year-old primigravida with a prolonged second stage of labour. He had a low APGAR score and was managed for severe perinatal asphyxia at the referral Centre. At presentation, He was conscious, not pale, anicteric, no edema with no dysmorphic features. Anthropometries were normal (weight was 2.8 kg, length 47 cm, OFC 37 cm). Had sutural diathesis, weak primitive reflexes, and hypotonia. No macroglossia or umbilical hernia. The stretched penile length was 2.7 cm. Magnetic Resonance Image showed cerebral and pituitary atrophy with hydrocephalus ex vacuo. Thyroid function test revealed central hypothyroidism and the serum cortisol was low (22.22 nmol/l). He was co-managed by a Paediatric neurologist with antiseizure medications, levothyroxine and hydrocortisone. There was some improvement in his activity and the seizure was controlled, however, hypothermia persisted.

Conclusion: Neonatal hypoxic-ischemic encephalopathy does involve the hypothalamic-pituitary axis and there should be a high index of suspicion.