| Abstract- 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. |