Diabetes insipidus and panhypopituitarism in a neonate with congenital toxoplasmosis

Abstract

Objectives – Although congenital toxoplasmosis (CTox) is asymptomatic in most cases, some infants/neonates present with variable clinical manifestations, including anaemia, jaundice, hepatosplenomegaly, seizures, hydrocephalus, chorioretinitis and sensorineural deafness. Involvement of the hypothalamic-pituitary axis is rarely reported with CTox. Case report – We present a full term baby girl who was admitted to the hospital on the 15th day of her life, due to an intense tremor and irritability. Brain ultrasound and CT exam revealed calcifications of the brain parenchyma and severe ventriculomegaly. Serological and molecular findings (positive specific immunoglobulin M and immunoglobulin G antibodies, polymerase chain reaction) confirmed CTox. After diagnosis was established, specific therapy with pyrimethamine, sulfodiazine and folic acid was started. On the fifth day of hospitalisation, laboratory findings revealed high serum sodium and chloride, high serum osmolality, low urine osmolality and low urine specific gravity. Since these findings strongly suggested the diagnosis of diabetes insipidus (DI) in this new born, further endocrinological workup was performed to assess the pituitary function. An ACTH (synacthen) stimulation test showed a low basal cortisol level with a positive response after administration of synacthen. The free thyroxin level was also low and repeated prolactin levels were high. On the basis of these findings, it was concluded that this new born has panhypopituitarism and diabetes insipidus. Hormonal substitution therapy with hydrocortisone, L-thyroxine and desmopressin was started and gradual normalization of electrolytes and hormonal status was noted. Conclusion – A continuous endocrinological monitoring of a child with CTox is important and necessary for early detection, timely therapy and prevention of severe sequelae.