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Growth hormone deficiency and diabetes insipidus as a complication of endoscopic third ventriculostomy

Kimberly S Tafuri1, Thomas A Wilson

  • 1Stony Brook University, Department of Pediatrics, Stony Brook Childrens Hospital, Division of Pediatric Endocrinology, Stony Brook, NY, U.S.A. Kimberly.Tafuri@stonybrookmedicine.edu

Journal of Clinical Research in Pediatric Endocrinology
|October 4, 2012
PubMed

Insights

Endoscopic third ventriculostomy (ETV) can cause rare pituitary complications. This case highlights a child with growth hormone deficiency and permanent diabetes insipidus (DI) after ETV, a unique presentation of multiple pituitary hormone deficiencies.

Area of Science:

  • Neurosurgery
  • Pediatric Endocrinology
  • Neuroendocrinology

Background:

  • Endoscopic third ventriculostomy (ETV) is a primary treatment for obstructive hydrocephalus.
  • Endocrinological complications following ETV in pediatric patients are infrequent.
  • Diabetes insipidus (DI) is the most common complication, typically transient and accounting for 0.5% of ETV-related issues.

Observation:

  • A 6-year-old girl developed growth hormone deficiency and permanent DI post-ETV.
  • This patient exhibited multiple pituitary hormone deficiencies, a previously undocumented complication of ETV.
  • The patient presented with a classical triphasic response of DI, further distinguishing this case.

Findings:

  • The presented case is the first documented instance of multiple pituitary hormone deficiencies after ETV.
  • The development of permanent DI and growth hormone deficiency suggests significant pituitary stalk compression or hypothalamic injury.
  • The triphasic DI response observed aligns with experimental findings in animal models.

Implications:

  • This case underscores the potential for severe, long-term endocrinological sequelae from ETV, even if rare.
  • It emphasizes the need for vigilant long-term endocrine monitoring in pediatric patients after ETV.
  • Understanding the mechanism of pituitary injury may inform procedural modifications to minimize risks.

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