283 NEONATAL HYPOGLYCEMIA ASSOCIATED WITH ANTERIOR HYPOPITUITARISM

Abstract

We have observed the association of profound hypoglycemia and anterior hypopituitarism in four newborns. All presented with hypoglycemia during the first 30 hours of life, which reached levels less than 10 mg.%. Rates of 20-30 mg./kg./min. of 20% dextrose were required to maintain glucose levels above 30 mg.%. All infants were products of complicated pregnancies and deliveries and had APGAR scores of five or less at one and five minutes. Measurements of anterior pituitary function including serum TSH, T4, ACTH, cortisol and growth hormone, in addition to metapyrone and cosyntropin stimulation, revealed anterior panhypopituitarism in three infants and isolated ACTH deficiency in the other. Posterior pituitary function was normal in all cases. Unresponsiveness of TSH to intravenous thyrotropin releasing hormone (TRH) and normal serum prolactin levels further support anterior pituitary dysfunction in contrast to a hypothalamic etiology. Autopsy on one infant revealed no anterior pituitary tissue. The three surviving patients are all doing well on appropriate hormone replacement. Micropenis was present in the one male and all infants showed a widening of the midfacies. This unappreciated cause of early neonatal hypoglycemia may be related to birth hypoxia or anatomic malformation of the anterior pituitary and its rudiments. These may be more susceptible to events at birth than previously appreciated and consequently this system should be more agressively evaluated in newborns.