Recurrent Severe Hypothermia as a Manifestation of Central Thermoregulatory Dysfunction in a Patient With Cerebral Palsy and Shaken Baby Syndrome

Recurrent hypothermia is an uncommon but clinically significant problem in adults with prior traumatic brain injury (TBI), such as shaken baby syndrome (SBS). Central thermoregulatory dysfunction, due to hypothalamic or autonomic injury, can lead to episodic hypothermia that mimics endocrine pathology. We describe a 38-year-old woman with cerebral palsy (CP) and a remote history of SBS presenting with recurrent hypothermia despite normal thyroid and adrenal function. Her episodes were initially treated empirically with corticosteroids, given concern for adrenal involvement, but recurrent events prompted multidisciplinary evaluation. Multiple infectious, endocrine, and neurologic assessments were negative for secondary causes. Imaging confirmed microcephaly and encephalomalacia consistent with prior TBI. Hypothermia was managed with supportive warming and steroid tapering. Neurology and endocrinology attributed her symptoms to hypothalamic hypoplasia or autonomic dysfunction resulting from her early brain injury. This case highlights the importance of recognizing central hypothermia as a long-term sequela of SBS to prevent unnecessary corticosteroid exposure and to improve supportive management.