98 Copyright © 2018 by the University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina. Department of Endocrinology, Department of Neonatology, Mother and Child Health Care Institute, Belgrade, Serbia Correspondence: danilovic.mirjana@yahoo.com Tel.: +381 11 3108 193 Fax.: +381 11 20 60 866 Received: December13, 2018 Accepted: January16, 2018 Key words: Congenital toxoplasmosis ■ Diabetes insipidus ■ Neonate. Diabetes insipidus and panhypopituitarism in a neonate with congenital toxoplasmosis Mirjana Danilović, Tatjana Milenković, Rade Vuković, Slađana Todorović, Jelena Martić, Katarina Pejić Central Eur J Paed 2018;14(1):98-101 DOI 10.5457/p2005-114.206 Objectives – Although congenital toxoplasmosis (CTox) is asymp- tomatic in most cases, some infants/neonates present with variable clinical manifestations, including anaemia, jaundice, hepatospleno- megaly, seizures, hydrocephalus, chorioretinitis and sensorineural deafness. Involvement of the hypothalamic-pituitary axis is rarely re- ported with CTox. Case report – We present a full term baby girl who was admitted to the hospital on the 15 th day of her life, due to an in- tense tremor and irritability. Brain ultrasound and CT exam revealed calcifcations of the brain parenchyma and severe ventriculomegaly. Serological and molecular fndings (positive specifc immunoglobu- lin M and immunoglobulin G antibodies, polymerase chain reaction) confrmed CTox. After diagnosis was established, specifc therapy with pyrimethamine, sulfodiazine and folic acid was started. On the ffth day of hospitalisation, laboratory fndings revealed high serum sodium and chloride, high serum osmolality, low urine osmolality and low urine specifc gravity. Since these fndings strongly suggested the di- agnosis of diabetes insipidus (DI) in this new born, further endocri- nological workup was performed to assess the pituitary function. An ACTH (synacthen) stimulation test showed a low basal cortisol level with a positive response after administration of synacthen. Te free thyroxin level was also low and repeated prolactin levels were high. On the basis of these fndings, it was concluded that this new born has panhypopituitarism and diabetes insipidus. Hormonal substitu- tion therapy with hydrocortisone, L-thyroxine and desmopressin was started and gradual normalization of electrolytes and hormonal status was noted. Conclusion – A continuous endocrinological monitoring of a child with CTox is important and necessary for early detection, timely therapy and prevention of severe sequelae. Introduction Congenital toxoplasmosis (CTox) results from the transplacental passage of the Toxo- plasma gondii parasite from mother to the foetus. Te risk of vertical transmission and the severity of foetal damage depends on the stage of pregnancy when the maternal infec- tion occurs. Although CTox is asymptomatic in most cases, some infants/neonates present with variable clinical manifestations, includ- ing anaemia, jaundice, hepatosplenomegaly, seizures, hydrocephalus, chorioretinitis and sensorineural hearing loss (1). Involvement of the hypothalamic-pituitary axis is rarely Case report