Endocrine Dysfunction in Children with Zika-Related Microcephaly Who Were Born during the 2015 Epidemic in the State
Andréia Veras Gonçalves1,2, Demócrito de B Miranda-Filho3, Líbia Cristina Rocha Vilela1
1Department of Tropical Medicine, Health Sciences Center, Federal University of Pernambuco, Recife 50670-901, Brazil.
Insights
Zika virus infection in infants can cause severe microcephaly and lead to significant endocrine dysfunctions, including short stature, hypothyroidism, and pubertal issues. Early endocrinological evaluation is crucial for timely diagnosis and treatment in affected children.
Area of Science:
- Pediatric Endocrinology
- Neurovirology
- Congenital Infections
Background:
- Congenital viral infections, including Zika, are linked to septo-optic dysplasia, suggesting a biological basis for endocrine dysfunction in Zika-related microcephaly.
- Septo-optic dysplasia involves optic nerve hypoplasia, midline brain abnormalities, and pituitary hypofunction.
Purpose of the Study:
- To identify and describe endocrine dysfunctions in children with severe Zika-related microcephaly.
- To highlight the need for endocrinological evaluation in this patient population.
Main Methods:
- A case series of 30 children with severe Zika-related microcephaly from the MERG Pediatric Cohort.
- Children were referred for endocrinological evaluation between February and August 2019.
Main Results:
- 97% of the children had severe microcephaly; the average age was 41 months.
- Common endocrine dysfunctions included short stature, hypothyroidism, obesity, and early puberty variants (57% alone, 43% in combination).
- Optic nerve hypoplasia (6/21), corpus callosum hypoplasia (20/21), and seizure crises (86%) were noted. Pubertal dysfunction, thyroid disease, growth impairment, and obesity were clinically significant.
Conclusions:
- Endocrine dysfunctions are prevalent in children with Zika-related microcephaly.
- Careful monitoring and early endocrinological evaluation are essential for managing growth, pubertal, and thyroid issues in these children.
Abstract:
Congenital viral infections and the occurrence of septo-optic dysplasia, which is a combination of optic nerve hypoplasia, abnormal formation of structures along the midline of the brain, and pituitary hypofunction, support the biological plausibility of endocrine dysfunction in Zika-related microcephaly. In this case series we ascertained the presence and describe endocrine dysfunction in 30 children with severe Zika-related microcephaly from the MERG Pediatric Cohort, referred for endocrinological evaluation between February and August 2019. Of the 30 children, 97% had severe microcephaly. The average age at the endocrinological consultation was 41 months and 53% were female. The most frequently observed endocrine dysfunctions comprised short stature, hypothyroidism, obesity and variants early puberty. These dysfunctions occurred alone 57% or in combination 43%. We found optic nerve hypoplasia (6/21) and corpus callosum hypoplasia (20/21). Seizure crises were reported in 86% of the children. The most common-and clinically important-endocrine dysfunctions were pubertal dysfunctions, thyroid disease, growth impairment, and obesity. These dysfunctions require careful monitoring and signal the need for endocrinological evaluation in children with Zika-related microcephaly, in order to make early diagnoses and implement appropriate treatment when necessary.
