Early-onset Refractory Neonatal Hypoglycaemia: An Unusual Presentation of Hypothalamic Hamartoma

Neonatal hypoglycaemia is a common metabolic emergency; however, persistent or refractory hypoglycaemia should prompt evaluation for endocrine and metabolic disorders. We report a case of a term female neonate with early-onset symptomatic hypoglycaemia found to be resistant to escalating glucose infusion rates and ultimately diagnosed with cortisol deficiency secondary to a hypothalamic hamartoma. Steroid therapy stabilised the blood glucose levels. This case underscores the importance of considering central endocrine causes in refractory neonatal hypoglycaemia and the role of neuroimaging in identifying rare aetiologies.