ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2021) 18 1.17 | DOI: 10.1530/ey.18.1.17

JAMA Netw Open. 2021 May 3;4(5):e219878. doi: 10.1001/jamanetworkopen.2021.987.

Ferreira et al. assessed postnatal growth and possible hypopituitarism at the age of 27 months in 65 children with microcephaly (head circumference, HC, < -2 S.D.) associated with congenital Zika virus (CZV) infection. Despite short stature, marked microcephaly and severe brain abnormalities, no case of growth hormone or thyrotropin deficiency was detected. However, central adrenal insufficiency and diabetes insipidus were diagnosed in a few patients.

Zika virus (ZV) was introduced to northeast Brazil between 2013-2015. It infects progenitor neuron cells, resulting in increased neuronal apoptosis and disturbed brain development during pregnancy. This study was based in Bahia, one of the Brazilian epicenters of the ZV epidemic. They evaluated clinical (micropenis, prolonged jaundice, neonatal hypoglycemia, poor growth, polyuria) and biochemical parameters (electrolytes, morning free T4, TSH, cortisol, ACTH, prolactin, IGF1, and IGFBP3, but no growth hormone stimulation tests).

Although CSV children were born SGA, they did not show postnatal catch-up growth and were short at evaluation (44.0% had length < -2 S.D.). 23 children had severe microcephaly (median HC -7.0 S.D.) and 29 children and mild/moderate microcephaly (HC -4.9 S.D.). Most of them (61/65) had severe brain abnormalities (e.g. midline brain defects, optic nerve atrophy or agenesis/ hypoplasia of corpus callosum).

Newly evolving viral diseases will present challenges for pediatric endocrinologists, but they also provide natural models to inform understanding of pituitary gland development and its vulnerability to various insults. Careful follow-up of CSK is warranted to show whether GH or other pituitary hormone deficiencies will develop.

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