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Adrenocortical insufficiency and refractory hypotension in preterm infants
  1. Pak Cheung Ng
  1. Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
  1. Correspondence to Professor Pak C Ng, Professor of Paediatrics, Department of Paediatrics, Level 6, Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong; pakcheungng{at}


Preterm, very low birthweight (VLBW) infants are prone to life-threatening hypotension secondary to hypothalamic-pituitary-adrenal axis immaturity, resulting in adrenocortical insufficiency. Clinical presentations of inotrope-resistant refractory hypotension are usually evident, but interpretation of serum cortisol may pose much difficulty to front-line neonatologists. This review examines the salient pathophysiology of adrenocortical insufficiency in the immediate postnatal period, characterises its endocrinological abnormalities, and describes the typical and variant clinical presentations. Based on existing evidence, a practical scheme is proposed for logical interpretation of circulating cortisol levels and management of inotrope-resistant refractory hypotension in VLBW infants.

  • Adrenocortical insufficiency
  • corticosteroids
  • cortisol
  • hypotension
  • VLBW infants

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  • Contributors PCN formulated the idea of writing this review for front-line neonatologists, performed the literature search, designed the layout of the article to include all relevant clinical information and wrote the entire manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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