Clinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus–Induced Microcephaly

Detalhes bibliográficos
Autor(a) principal: Ferreira, Leda L.
Data de Publicação: 2021
Outros Autores: Aguilar Ticona, Juan Pablo, Mattos, Paulo Sérgio de Morais da Silveira, Arriaga Gutiérrez, María Belen, Moscato, Thaisa B., Conceição, Gildásio C., Santos, Antonio Carlos dos, Costa, Federico, Alves, Crésio A.D., Antonini, Sonir R.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/48657
Resumo: Escola Bahiana de Medicina e Saúde Pública. Programa de Pós-graduação em Medicina e Saúde Humana. Salvador, BA, Brasil / Universidade Federal da Bahia. Hospital University Hospital Professor Edgard Santos, Salvador, BA, Brasil.
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spelling Ferreira, Leda L.Aguilar Ticona, Juan PabloMattos, Paulo Sérgio de Morais da SilveiraArriaga Gutiérrez, María BelenMoscato, Thaisa B.Conceição, Gildásio C.Santos, Antonio Carlos dosCosta, FedericoAlves, Crésio A.D.Antonini, Sonir R.2021-08-17T17:20:58Z2021-08-17T17:20:58Z2021FERREIRA, Leda L. et al. Clinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus–Induced Microcephaly. JAMA Network Open, 2021.2574-3805https://www.arca.fiocruz.br/handle/icict/4865710.1001/jamanetworkopen.2021.9878engAmerican Medical AssociationMicrocefaliaZika virusSistema Nervoso CentralHipopituitarismoInfecçõesMicrocephalyZika virusCentral Nervous SystemHypopituitarismInfectionsClinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus–Induced Microcephalyinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleEscola Bahiana de Medicina e Saúde Pública. Programa de Pós-graduação em Medicina e Saúde Humana. Salvador, BA, Brasil / Universidade Federal da Bahia. Hospital University Hospital Professor Edgard Santos, Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Bahia, Brasil / Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Bahia, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Bahia, Brasil.Associação de Pais e Amigos dos Excepcionais. Salvador, BA, Brasil.University of Sao Paulo. Ribeirao Preto Medical School. Department of Medical Imaging, Hematology and Oncology. Sao Paulo, SP, Brazil.Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brasil.University of Sao Paulo. Ribeirao Preto Medical School. Department of Pediatrics. Sao Paulo, SP, Brazil.The Zika virus infects progenitor neuron cells, disrupts cerebral development, and, in mice, drives hypothalamic defects. Patients with microcephaly caused by congenital Zika infection present with midline cerebral defects, which may result in hypopituitarism. OBJECTIVE To analyze postnatal growth and the presence of clinical and biochemical features associated with hypopituitarism in children with congenital Zika infections. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort study at 2 public referral hospitals in Bahia, Brazil, specializing in the treatment of congenital Zika infection, clinical data and growth parameters of 65 patients with the infection were evaluated. Data were analyzed from April 2017 through July 2018. EXPOSURE Congenital Zika infection. MAIN OUTCOMES AND MEASURES Length, weight, and head circumference were measured at birth and during follow up (ie, at 27 months of life) for each patient. Basal levels of free thyroxine, thyrotropin, cortisol, corticotropin, prolactin, insulin-like growth factor 1, insulin-like growth factor binding protein 3, urine and plasma osmolality, electrolytes, glucose, and insulin were evaluated at the age of 26 months to 28 months. All patients underwent central nervous system computed tomography scans and ophthalmic and otoacoustic evaluations at the time of this investigation or had done so previously. RESULTS Among 65 patients (38 [58.4%] male; median [interquartile range] age at enrollment, 27 [26-28] months), 61 patients presented with severe brain defects (93.8%), including corpus callosum agenesis or hypoplasia (ie, midline brain defects; 25 patients [38.5%]) and optic nerve atrophy (38 patients [58.5%]). Most patients presented with severe neurodevelopmental delay (62 of 64 patients [96.9%]). Past or present clinical signs of hypopituitarism were rare, occurring in 3 patients (4.6%). Severe microcephaly, compared with mild or moderate microcephaly, was associated with a shorter length by median (interquartile range) z score at birth (−1.9 [−2.5 to −1.0] vs −0.3 [−1.0 to 0]; P < .001), but this difference did not persist at 27 months (−1.6 [−2.3 to −0.3] vs −2.9 [−4.0 to −1.2]; P = .06). Growth hormone deficiency or hypothyroidism were not observed in any patients, and glucose and insulin levels were within reference ranges for all patients. Low cortisol levels (ie, below 3.9 μg/dL) were observed in 4 patients (6.2%). These 4 patients presented with low (ie, below 7.2 pg/mL) or inappropriately low (ie, below 30 pg/mL) corticotropin levels. Low corticotropin levels (ie, below 7.2 pg/mL) were observed in 6 patients (9.2%). Diabetes insipidus was evaluated in 21 patients; it was confirmed in 1 patient (4.8%) and suggested in 3 patients (14.3%). CONCLUSIONS AND RELEVANCE This study found that congenital Zika infection with microcephaly was associated with midline brain defects and optic nerve atrophy. Children with congenital Zika infections presented with prenatal growth impairments with a lack of postnatal catch-up, as shown by persistent short length from birth until 27 months; these impairments were not associated with growth hormone deficiency. Patients also presented with severe developmental delay thatwas not associated with hypothyroidism, while central adrenal insufficiency and diabetes insipidus occurred in some patients.info:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-83097https://www.arca.fiocruz.br/bitstream/icict/48657/1/license.txt36b51ef91c52b5338d9d29ba0cc807bcMD51ORIGINALFerreira, Leda L Clinical....pdfFerreira, Leda L Clinical....pdfapplication/pdf1567702https://www.arca.fiocruz.br/bitstream/icict/48657/2/Ferreira%2c%20Leda%20L%20Clinical....pdff82c104dc2109c79d63fa329bb13ccceMD52TEXTFerreira, Leda L Clinical....pdf.txtFerreira, Leda L Clinical....pdf.txtExtracted texttext/plain58646https://www.arca.fiocruz.br/bitstream/icict/48657/3/Ferreira%2c%20Leda%20L%20Clinical....pdf.txt3e5a191ecba114fc83b86a3b17b05953MD53icict/486572023-03-15 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dc.title.pt_BR.fl_str_mv Clinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus–Induced Microcephaly
title Clinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus–Induced Microcephaly
spellingShingle Clinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus–Induced Microcephaly
Ferreira, Leda L.
Microcefalia
Zika virus
Sistema Nervoso Central
Hipopituitarismo
Infecções
Microcephaly
Zika virus
Central Nervous System
Hypopituitarism
Infections
title_short Clinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus–Induced Microcephaly
title_full Clinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus–Induced Microcephaly
title_fullStr Clinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus–Induced Microcephaly
title_full_unstemmed Clinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus–Induced Microcephaly
title_sort Clinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus–Induced Microcephaly
author Ferreira, Leda L.
author_facet Ferreira, Leda L.
Aguilar Ticona, Juan Pablo
Mattos, Paulo Sérgio de Morais da Silveira
Arriaga Gutiérrez, María Belen
Moscato, Thaisa B.
Conceição, Gildásio C.
Santos, Antonio Carlos dos
Costa, Federico
Alves, Crésio A.D.
Antonini, Sonir R.
author_role author
author2 Aguilar Ticona, Juan Pablo
Mattos, Paulo Sérgio de Morais da Silveira
Arriaga Gutiérrez, María Belen
Moscato, Thaisa B.
Conceição, Gildásio C.
Santos, Antonio Carlos dos
Costa, Federico
Alves, Crésio A.D.
Antonini, Sonir R.
author2_role author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Ferreira, Leda L.
Aguilar Ticona, Juan Pablo
Mattos, Paulo Sérgio de Morais da Silveira
Arriaga Gutiérrez, María Belen
Moscato, Thaisa B.
Conceição, Gildásio C.
Santos, Antonio Carlos dos
Costa, Federico
Alves, Crésio A.D.
Antonini, Sonir R.
dc.subject.other.pt_BR.fl_str_mv Microcefalia
Zika virus
Sistema Nervoso Central
Hipopituitarismo
Infecções
topic Microcefalia
Zika virus
Sistema Nervoso Central
Hipopituitarismo
Infecções
Microcephaly
Zika virus
Central Nervous System
Hypopituitarism
Infections
dc.subject.en.pt_BR.fl_str_mv Microcephaly
Zika virus
Central Nervous System
Hypopituitarism
Infections
description Escola Bahiana de Medicina e Saúde Pública. Programa de Pós-graduação em Medicina e Saúde Humana. Salvador, BA, Brasil / Universidade Federal da Bahia. Hospital University Hospital Professor Edgard Santos, Salvador, BA, Brasil.
publishDate 2021
dc.date.accessioned.fl_str_mv 2021-08-17T17:20:58Z
dc.date.available.fl_str_mv 2021-08-17T17:20:58Z
dc.date.issued.fl_str_mv 2021
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.citation.fl_str_mv FERREIRA, Leda L. et al. Clinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus–Induced Microcephaly. JAMA Network Open, 2021.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/48657
dc.identifier.issn.pt_BR.fl_str_mv 2574-3805
dc.identifier.eissn.none.fl_str_mv 10.1001/jamanetworkopen.2021.9878
identifier_str_mv FERREIRA, Leda L. et al. Clinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus–Induced Microcephaly. JAMA Network Open, 2021.
2574-3805
10.1001/jamanetworkopen.2021.9878
url https://www.arca.fiocruz.br/handle/icict/48657
dc.language.iso.fl_str_mv eng
language eng
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv American Medical Association
publisher.none.fl_str_mv American Medical Association
dc.source.none.fl_str_mv reponame:Repositório Institucional da FIOCRUZ (ARCA)
instname:Fundação Oswaldo Cruz (FIOCRUZ)
instacron:FIOCRUZ
instname_str Fundação Oswaldo Cruz (FIOCRUZ)
instacron_str FIOCRUZ
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reponame_str Repositório Institucional da FIOCRUZ (ARCA)
collection Repositório Institucional da FIOCRUZ (ARCA)
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