A male neonate failing to thrive with an endocrine disorder

Failure to thrive (FTT) is weight consistently below the 3rd to 5th percentile for age and sex, progressive decrease in weight to below the 3rd to 5th percentile, or a decrease in two major growth percentiles in a short period. The cause may be an identified medical condition, may be related to environmental factors, or may be multifactorial. Congenital adrenal hypoplasia (CAH), an endocrine disorder, is a rare cause of FTT in the newborn. We report a male neonate with FTT secondary to suspected CAH, salt-losing form. The case is reported to orient clinicians to have a high index of suspicion for any neonate who is failing to thrive. A 25-day-old male neonate presented with a history of poor weight gain. Weight at presentation was 2.8 kg, and birth weight was 3.7 kg (had lost 24% of birth weight). Mother is a 35-year-old Para 3 (3 Alive) woman who had a good appetite and was lactating well. Initial random blood sugar (RBS) was 117 mg/dL, but within minutes, she was observed to be unconscious, with a repeat RBS of 39 mg/dL. A thorough physical examination revealed a hyperpigmented male phallus with a stretched penile length of 4.8 cm and testicular volume of 2 cm3 using a standard orchidometer. Investigation results revealed hyponatremia, hyperkalemia, metabolic acidosis, with normal urea and creatinine levels. Full blood count parameters were essentially within the normal range. Serum cortisol, 17-hydroxyprogesterone, serum testosterone, and serum dehydroepiandrosterone-sulfate were not done. The patient was managed conservatively with dextrose-containing fluid and correction of electrolyte derangement. Weight was 2.7 kg on discharge. Weight on follow-up was 3.2 kg.