Endocrine Abstracts

A 32-year old Caucasian was admitted with at 14 weeks of gestation with hypotension and weight loss. Family members noted that she appeared ‘tired’ prior to pregnancy. Past medical history included primary hypothyroidism treated with thyroxine (100 μg/day). Her mother had also been hypothyroid. She had a healthy daughter aged 2.5 years who had been born small for gestational age.

At about 8 weeks of gestation she started to vomit several times a day and after each meal. She was admitted and treated with antiemetics and intravenous fluids. Following discharge she remained nauseated, weak and lightheaded and lost about 8 kg of weight. After readmission and appeared ill and dehydrated, BMI 16.6 kg/m², BP 90/60 mmHg supine, 70/50 mmHg upright (with faint-like sensation), normal heart sounds, chest clinically clear, abdomen soft and not tender. Investigations revealed sodium 112 mmol/l, potassium 4.3 mmol/l, normal renal function, TSH 1.31 μIU/ml (reference range (RR): 0.27–4.2), FreeT₄ 1.99 ng/dl (RR 0.93–1.7), FreeT₃ 3.29 pg/ml (RR 2.57–4.43), anti-TPO antibodies 466.9 IU/ml (RR <34). She was hyperpigmented and remained hypotensive and hyponatraemic despite rehydration. Cortisol & ACTH, followed by a 250 μg short synacthen test were requested and revealed:

Pending results she was started on Hydrocortisone and started to feel tremendously better A diagnosis of Addison’s disease was made (possibly as a part of autoimmune polyglandular syndrome type II). She was discharged on standard hydrocortisone & fludrocortisone replacement. Remarkably, despite the severity of the above problems, there was no evidence of significant fetal growth delay.

Conclusions: New onset Addisson’s disease is rare in pregnancy, but may present with prolonged vomiting and weight loss. Therefore adrenal failure should be included in the differential diagnosis of hyperemesis gravidarum.