Premature infants are at risk for transient adrenal insufficiency.

Clinical features:

(1) very low birthweight preterm infant (often < 30 weeks)

(2) concurrent illness including respiratory distress

(3) hypotension refractory to usual interventions (fluids, inotropes)

(4) rapid improvement after administration of corticosteroids

(5) exclusion of sepsis and other causes of shock


Mechanism: immaturity of the hypothalamic-pituitary-adrenal axis with failure of the adrenal glands to produce enough cortisol

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