Hypothalamopituitary deficiency and precocious puberty following hyperhydration in diabetic ketoacidosis.
We report on a 5-year-old child who survived an intracerebral crisis, following ketoacidosis-revealing diabetes (DKA), with visual impairment due to a vascular occipital lesion. Two and 4 months after the initial episode, a unique hypothalamopituitary disorder consisting in GH, ACTH, TSH deficiencies and central precocious puberty, was detected. Cranial magnetic resonance images showed no visible lesion in the hypothalamopituitary region. The most likely hypothesis is the ischemia of hypothalamopituitary and occipital regions following possible cerebral edema after hyperhydration. She survived with low visual acuteness and received a combined replacement therapy for the neuroendocrinological deficiencies. This case emphasizes that the rehydration at the initial period of DKA is critical, especially when risk factors for cerebral edema are present (young age, marked hyponatremia). The neuroendocrinological consequences of acute cerebral edema are rare, but physicians must be attentive in survivors of these accidents.
Tubiana-Rufi
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N
Service d'Endocrinologie et de Diabétologie Pédiatriques, Hôpital Robert-Debré, Paris, France.
Thizon-de Gaulle
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I
Czernichow
P
P
D000324:Adrenocorticotropic Hormone / Q000172:deficiency; D001929:Brain Edema / Q000209:etiology; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000150:complications* / Q000628:therapy; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D013006:Growth Hormone / Q000172:deficiency; D006801:Humans; D007027:Hypothalamic Diseases / Q000209:etiology* / Q000503:physiopathology; D007031:Hypothalamus / Q000098:blood supply; D007511:Ischemia; D010900:Pituitary Diseases / Q000209:etiology* / Q000503:physiopathology; D010902:Pituitary Gland / Q000098:blood supply; D011629:Puberty, Precocious / Q000209:etiology*; D013972:Thyrotropin / Q000172:deficiency
D000324:Adrenocorticotropic Hormone; D013972:Thyrotropin; D013006:Growth Hormone