{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:01:07Z","timestamp":1753887667379,"version":"3.41.2"},"reference-count":29,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,1]]},"abstract":"<jats:p>We report a case of a 17-month-old boy with developmental delay who presented with acute-onset right-sided hemiparesis and hypoglycemia. Severe hypotension developed during his sedation for MRI and magnetic resonance angiography. Imaging revealed a hypoplastic pituitary gland within a shallow sella turcica and findings suggestive of moyamoya syndrome. Hemiparesis resolved 5 hours after correction of hypoglycemia with dextrose infusion, and severe hypotension improved with crystalloid fluids and vasopressors. Magnetic resonance angiography repeated 24 hours later revealed resolution of the vascular finding. Additional biochemical testing was consistent with hypopituitarism, and genetic evaluation revealed that the patient had a microdeletion including the LHX4 gene, which has been implicated in combined pituitary hormone deficiency type IV. Hypoglycemia frequently presents with autonomic or neuroglycopenic symptoms. However, when hypoglycemia presents with an isolated neurologic deficit like hemiparesis with preservation of alertness, it can be challenging to differentiate a cerebrovascular event from hypoglycemia-induced symptoms, leading to a delay in endocrine evaluation. Hypoglycemic hemiparesis is rare in childhood and is reported in children with diabetes mellitus or hyperinsulinism. This case expands the clinical spectrum of hemiparesis as a presenting sign of hypoglycemia in growth hormone and adrenocorticotropic hormone\/cortisol deficiencies.<\/jats:p>","DOI":"10.1542\/peds.2021-050995","type":"journal-article","created":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T08:07:02Z","timestamp":1644912422000},"source":"Crossref","is-referenced-by-count":0,"title":["Hemiparesis With Hypoglycemia in a Child With Hypopituitarism Involving <i>LHX4<\/i> Gene Deletion"],"prefix":"10.1542","volume":"149","author":[{"given":"Leah","family":"Akinseye","sequence":"first","affiliation":[{"name":"Divisions of Pediatric Endocrinology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jewel","family":"Ward","sequence":"additional","affiliation":[{"name":"Clinical Genetics, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit","family":"Lahoti","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Endocrinology"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2022,2,15]]},"reference":[{"issue":"3","key":"2022030200061584600_B1","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/0736-4679(89)90351-X","article-title":"Hypoglycemic hemiplegia in an adolescent with insulin-dependent diabetes mellitus: a case report and a review of the literature","volume":"7","author":"Lala","year":"1989","journal-title":"J Emerg Med"},{"issue":"8","key":"2022030200061584600_B2","doi-asserted-by":"crossref","first-page":"4043","DOI":"10.1210\/jc.2010-0150","article-title":"Mutation and gene copy number analyses of six pituitary transcription factor genes in 71 patients with combined pituitary hormone deficiency: identification of a single patient with LHX4 deletion","volume":"95","author":"Dateki","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"2022030200061584600_B3","doi-asserted-by":"crossref","first-page":"e529","DOI":"10.1542\/peds.2010-3849","article-title":"Panhypopituitarism presenting as life-threatening heart failure caused by an inherited microdeletion in 1q25 including LHX4","volume":"129","author":"Filges","year":"2012","journal-title":"Pediatrics"},{"issue":"707","key":"2022030200061584600_B4","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1136\/pgmj.60.707.577","article-title":"Neurological aspects of insulinomas","volume":"60","author":"Daggett","year":"1984","journal-title":"Postgrad Med J"},{"issue":"5","key":"2022030200061584600_B5","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1161\/01.STR.18.5.944","article-title":"Hypoglycemic hemiplegia: two cases and a clinical review","volume":"18","author":"Foster","year":"1987","journal-title":"Stroke"},{"issue":"9","key":"2022030200061584600_B6","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1016\/j.amjmed.2014.06.001","article-title":"Hypoglycemic hemiparesis: the stroke masquerader","volume":"127","author":"Nannapaneni","year":"2014","journal-title":"Am J Med"},{"issue":"3","key":"2022030200061584600_B7","doi-asserted-by":"crossref","first-page":"347","DOI":"10.3109\/03009734.2011.652748","article-title":"A case of hypoglycemic hemiparesis and literature review","volume":"117","author":"Yoshino","year":"2012","journal-title":"Ups J Med Sci"},{"issue":"3","key":"2022030200061584600_B8","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/S0736-4679(98)00010-9","article-title":"Hemiparesis and altered mental status in a child after glyburide ingestion","volume":"16","author":"Spiller","year":"1998","journal-title":"J Emerg Med"},{"issue":"5","key":"2022030200061584600_B9","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1210\/jcem-13-5-587","article-title":"Medical aspects of hypoglycemia","volume":"13","author":"Skillern","year":"1953","journal-title":"J Clin Endocrinol Metab"},{"key":"2022030200061584600_B10","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1542\/peds.25.5.748","article-title":"Idiopathic spontaneous hypoglycemia in children. 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