# Endocrinopathies in a Pediatric Patient Post-anatomical Hemispherectomy for Rasmussen’s Encephalitis Treatment: A Case Report

## TL;DR

A child who had a brain surgery for Rasmussen's encephalitis later developed several hormone-related issues, highlighting the need for long-term endocrine monitoring in similar cases.

## Contribution

This case report highlights previously underreported endocrinopathies following anatomical hemispherectomy in pediatric patients.

## Key findings

- The patient developed central diabetes insipidus immediately after surgery.
- The patient showed signs of central precocious puberty and secondary adrenal insufficiency.
- The patient experienced early menarche at age seven.

## Abstract

Hemispherectomy is a neurosurgical procedure that is frequently performed in pediatric patients diagnosed with Rasmussen's encephalitis. Postoperative complications include immediate complications such as hydrocephalus and hemorrhage and behavioral complications such as language impairments and contralateral weakness. However, there are limited studies or case reports that address the potential endocrinopathies associated with this and other pediatric epileptic surgeries. This case report describes the endocrinopathies following an anatomical hemispherectomy procedure.

A four-year-old African-American female had a right anatomical hemispherectomy for the treatment of Rasmussen's encephalitis in 2020. The postoperative course was immediately complicated by central diabetes insipidus which was stabilized with desmopressin. The patient’s labs in 2021 were consistent with central precocious puberty with elevated luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Additionally, the patient was found to have secondary adrenal insufficiency in which she failed a low-dose adrenocorticotropic hormone (ACTH) stimulation test. Oral hydrocortisone therapy was initiated for secondary adrenal insufficiency in addition to initiating leuprolide injections for central precocious puberty. Furthermore, at the age of seven years, the patient had her first menarche.

This case report emphasizes the need for closer and long-term surveillance for endocrine issues in postepileptic surgical pediatric patients as well as a surveillance plan for the development of other potential endocrine abnormalities throughout the patient’s life.