Hypothalamic pituitary axis dysfunction in a neonate with severe Hypoxic-ischemic encephalopathy

Severe hypoxic-ischemic encephalopathy (HIE) in the newborn period is known to cause multi-organ dysfunction. Our index case describes a 40 weeks newborn infant who was born in a depressed state with poor cord gases and Apgar scores and needed cardiopulmonary resuscitation. During the 2 nd week of life, the newborn infant became polyuric with persistent hypernatremia along with problems in maintaining body temperature. Investigations revealed the newborn infant to suffer from neurogenic diabetes insipidus, secondary adrenal, and thyroid insufficiency. Magnetic resonance imaging of the brain showed abnormal heterogeneous signals within the thalami and basal ganglia consistent with severe HIE. Commencement of regular desmopressin, hydrocortisone, and levothyroxine resulted in the improvement of hypernatremia, polyuria, thyroid functions, and serum cortisol levels but unstable thermoregulation continued to persist. Such multiple endocrinopathies involving both the anterior and posterior pituitary gland and hypothalamus as sequelae to severe HIE in newborn infants have not been widely reported in the literature.