{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:03:37Z","timestamp":1756339417715,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,7,16]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>The rarity of congenital hypopituitarism (CHP) makes it essential for clinicians to be aware of its varying clinical manifestations. We report a neonate with one such unique presentation. A preterm girl baby was managed for respiratory distress. Diffuse cutis marmorata was present since birth; septic screens were positive with placental histopathology showing chorioamnionitis. Newborn screening showed low free thyroxine and normal TSH. Transient hypothyroxinaemia of prematurity was considered. Her respiratory status worsened on day 9, followed by refractory shock. She was treated for sepsis. Further evaluation for absent heart rate variability in response to vasopressor resistant shock led to the detection of hypocortisolism. Low cortisol along with hypothyroxinaemia made hypopituitarism the working diagnosis. Owing to the variable clinical spectrum of CHP, diagnosis is challenging. We highlight a few clinical and laboratory features, which would help in earlier diagnosis of CHP.<\/jats:p>","DOI":"10.1136\/bcr-2021-244414","type":"journal-article","created":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T12:10:27Z","timestamp":1627906227000},"page":"e244414","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Hypothyroxinaemia in refractory shock: a clue to diagnose hypopituitarism"],"prefix":"10.1136","volume":"14","author":[{"given":"Susmitha","family":"Tangirala","sequence":"first","affiliation":[{"name":"Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prakash","family":"Amboiram","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8132-9574","authenticated-orcid":false,"given":"Umamaheswari","family":"Balakrishnan","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9487-4651","authenticated-orcid":false,"given":"Usha Devi","family":"Rajendran","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,2]]},"reference":[{"key":"2025082703524286000_14.8.e244414.1","doi-asserted-by":"crossref","first-page":"600962","DOI":"10.3389\/fped.2020.600962","article-title":"Congenital hypopituitarism during the neonatal period: epidemiology, pathogenesis, therapeutic options, and outcome","volume":"8","author":"Bosch I Ara","year":"2020","journal-title":"Front Pediatr"},{"key":"2025082703524286000_14.8.e244414.2","doi-asserted-by":"crossref","first-page":"222","DOI":"10.4038\/sljch.v42i4.6270","article-title":"Cutis marmorata as a manifestation of congenital hypothyroidism","volume":"42","author":"Ahmad","year":"2013","journal-title":"Sri Lanka J Child Health"},{"key":"2025082703524286000_14.8.e244414.3","doi-asserted-by":"publisher","DOI":"10.1542\/neo.19-12-e742"},{"key":"2025082703524286000_14.8.e244414.4","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1007\/s12098-017-2575-y","article-title":"Newborn Screening Guidelines for Congenital Hypothyroidism in India: Recommendations of the Indian Society for Pediatric and Adolescent Endocrinology (ISPAE) - Part I: Screening and Confirmation of Diagnosis","volume":"85","author":"Desai","year":"2018","journal-title":"Indian J Pediatr"},{"key":"2025082703524286000_14.8.e244414.5","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-0915"},{"key":"2025082703524286000_14.8.e244414.6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-0806"},{"key":"2025082703524286000_14.8.e244414.7","doi-asserted-by":"publisher","DOI":"10.1159\/000452150"},{"key":"2025082703524286000_14.8.e244414.8","doi-asserted-by":"crossref","DOI":"10.1038\/pr.2011.482","article-title":"Expression of adrenoceptor subtypes in the preterm pig heart","volume":"70","author":"Kim","year":"2011","journal-title":"Pediatr Res"},{"key":"2025082703524286000_14.8.e244414.9","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1109\/JBHI.2020.3021662","article-title":"Early detection of late onset sepsis in premature infants using visibility graph analysis of heart rate variability","volume":"25","author":"Le\u00f3n","year":"2021","journal-title":"IEEE J Biomed Health Inform"},{"key":"2025082703524286000_14.8.e244414.10","doi-asserted-by":"crossref","first-page":"86","DOI":"10.3389\/fped.2018.00086","article-title":"Treating hypotension in preterm neonates with vasoactive medications","volume":"6","author":"Joynt","year":"2018","journal-title":"Front Pediatr"},{"key":"2025082703524286000_14.8.e244414.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2005.03.008"},{"key":"2025082703524286000_14.8.e244414.12","doi-asserted-by":"crossref","unstructured":"Ibrahim H , Sinha IP , Subhedar NV . 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