Ng Pak Cheung
Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Arch Dis Child Fetal Neonatal Ed. 2016 Nov;101(6):F571-F576. doi: 10.1136/archdischild-2016-311289. Epub 2016 Sep 6.
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.
早产、极低出生体重（VLBW）婴儿容易因下丘脑-垂体-肾上腺轴不成熟而出现危及生命的低血压，导致肾上腺皮质功能不全。对血管活性药物抵抗的难治性低血压的临床表现通常很明显，但血清皮质醇的解读可能给一线新生儿科医生带来很大困难。本文综述探讨了出生后即刻肾上腺皮质功能不全的显著病理生理学，描述其内分泌异常，并阐述典型和变异的临床表现。基于现有证据，提出了一个实用方案，用于合理解读极低出生体重婴儿循环皮质醇水平及管理对血管活性药物抵抗的难治性低血压。
