even rarer is the successful diagnosis and management of this condition in the neonatal period , especially when accompanied by other comorbid conditions . a male infant weighing 3.88 kg ( 5075 centile ) was born at 42 + 1 weeks of gestation by emergency lower segment caesarean section performed for failed induction . his mother had active oral herpes at the time of delivery . the maternal medical history , family history , and antenatal history were unremarkable , including antenatal scans and maternal serology . he was born in good condition with a normal apgar score and was transferred to the postnatal ward with his mother . his head circumference was 36.5 cm ( 75 centile ) and length was 52.8 cm ( 25 centile ) . at 4 h of age , he was noted to be hypothermic ( 34.2c ) and hypoglycemic ( blood glucose 1.0 mmol / l ) . on examination , he was noted to have micropenis ( stretched penile length 1.25 cm ) and left testis was not palpable in the scrotum . a working diagnosis of congenital hypopituitarism ( ch ) with a possible herpes infection was made . he had a hypoglycemia screening and needed two dextrose boluses to normalize his blood glucose . he was placed in an incubator , to correct hypothermia , which slowly responded to high ambient temperature . he was noted to have hypotension and tachycardia for which he received two normal saline boluses , which improved his cardiovascular status . he was started on maintenance fluids and first - line antibiotics along with intravenous aciclovir . these antibiotics were later stopped as his bacterial and viral cultures from blood and vesicular fluid were negative . by the second day of life , this was thought to be secondary to the initial cardiovascular compromise and hypotensive insult secondary to low cortisol levels . this was managed with standard renal failure guidelines including fluid restriction and careful monitoring of electrolyte status . by seventh day of life , his renal function started improving and he was gradually established on feeds and was normalized . his initial hypoglycemia screening on admission revealed very low cortisol ( < 7 nmol / l ) , growth hormone ( < 0.05 g / l ) , and low free t4 ( 11.4 pmol / l ) concentrations . the doses of hydrocortisone and l - thyroxin were optimized to 2 mg / kg four times a day and 50 g once daily , respectively . an ophthalmological review suggested a possibility of right hypoplastic optic disc , which was ruled out by magnetic resonance imaging ( mri ) . sick day rules. they were also taught about the administration of intramuscular hydrocortisone and buccal administration of hypostop . a follow - up at 5 weeks of age revealed normal growth and development with normal tone and activity . pituitary deficiency is the second most frequent cause of persistent neonatal hypoglycemia , the first one being congenital hyperinsulinism . the associated clinical features may include midline cleft lip or palate , single central incisor , or optic nerve hypoplasia . micropenis is an important sign in neonates since it may be the only clue to the diagnosis of panhypopituitarism . the diagnosis of hypopituitarism must be based on clinical grounds , especially when hypoglycemia , prolonged jaundice , micropenis , or midline alterations are found in the neonatal period . neonatal presentation may be mistaken for sepsis , which can present with similar clinical features of hypothermia , hypoglycemia , lethargy , and poor feeding . the initial investigation and management should be aimed at stabilizing the clinical status of the baby . but any suspicion in the presence of any or all of the above clinical features should be a trigger for the investigation of hypopituitarism . by far anterior pituitary is the most common lobe to be involved , but both anterior and posterior pituitary may be affected . adrenocorticotrophic hormone ( acth ) , thyroid stimulating hormone ( tsh ) , follicle stimulating hormone ( fsh ) , luteinizing hormone ( lh ) , growth hormone ( gh ) , and prolactin may be deficient along with partial or complete absence of vasopressin . it has been suggested that they can have an iq that is below average when compared with the population norm and a reduced performance iq when compared with sibling controls . in our patient , the presentation of hypoglycemia and hypothermia was very suggestive of ch in the presence of micropenis . the onset of renal failure suggested that any further delay in the treatment could have been life - threatening . this case also highlighted that ch can be associated with a variety of metabolic disturbances , and renal failure is one of them .
congenital hypopituitarism is potentially fatal in the newborn period but treatable if the diagnosis is made early . 
 we report a neonate who presented with hypothermia and severe hypoglycemia . 
 he also had undescended testis and micropenis . 
 initial screening revealed panhypopituitarism , which was corrected promptly . 
 he developed renal failure due to initial cardiovascular compromise related to hypotension but recovered quickly with standard management . 
 magnetic resonance imaging revealed absent stalk of anterior pituitary .