Mousavi Hadi, Bakhtiyari Salar
Department of Pediatrics, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran..
Department of Clinical Biochemistry, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran..
Acta Med Iran. 2014;52(1):82-4.
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.
新生儿意识水平降低可能由不同病因引起，包括由于垂体前叶功能不全导致的罕见代谢和激素紊乱。在本病例报告中，一名五天大的男婴被转诊至伊朗伊拉姆省穆斯塔法·霍梅尼医院的新生儿重症监护病房。他前囟门未闭，无产前及家族疾病史。临床检查显示意识水平降低，该患者仅对疼痛刺激有反应。此外，昏迷、高胆红素血症和肌张力减退也十分明显。鉴于临床表现和意识水平降低，进行了激素诊断测试和脑部CT扫描以寻找垂体功能减退的证据。临床和实验结果与中枢性甲状腺功能减退和皮质醇缺乏继发的全身性水肿和垂体功能不全相符。基于这些发现，该新生儿接受了激素替代治疗，结果所有异常临床症状均消失。总之，致命的新生儿疾病在初次检查时可能会被误诊为不重要的临床发现。因此，应全面关注新生儿此类症状的所有潜在病因，以便早期诊断和治疗，并预防任何致命和不可逆转的并发症。
