Refractory hypotension in preterm infants with adrenocortical insufficiency.
Five preterm, very low birthweight infants with severe hypotension and adrenocortical insufficiency are described. The profound hypotension was resistant to volume expansion and inotrope treatment, but responded promptly to corticosteroid treatment. A human corticotrophin releasing hormone (hCRH) test performed before corticosteroid treatment showed adequate pituitary response, and the endocrine dysfunction was identified at the adrenal level. Corticosteroid treatment should be considered and could be life saving in severely hypotensive preterm infants who do not respond to conventional treatment with volume expanders and inotropes.
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PC
Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong. pakcheungng@cuhk.edu.hk
Lam
C W
CW
Fok
T F
TF
Lee
C H
CH
Ma
K C
KC
Chan
I H
IH
Wong
E
E
D000309:Adrenal Insufficiency / Q000150:complications* / Q000175:diagnosis; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003346:Corticotropin-Releasing Hormone / Q000032:analysis / Q000502:physiology; D003937:Diagnosis, Differential; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000502:physiology; D007022:Hypotension / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D019102:Infant, Very Low Birth Weight / Q000502:physiology*; D008297:Male; D010901:Pituitary Function Tests; D010952:Plasma Substitutes / Q000627:therapeutic use; D012772:Shock, Septic / Q000175:diagnosis; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D005938:Glucocorticoids; D010952:Plasma Substitutes; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone