Endocrine Abstracts

Background: Adrenal insufficiency (AI) in pregnant women is difficult to manage because of similarity between clinics of decompensation of AI and gestational toxicosis. Objective difficulty is absence of clinical guidelines of management of pregnant patients with AI. We present a clinical case where the management of pregnant patient was not careful, which led to overdose and iatrogenic hypercortisolism.

Clinical case: Pregnant woman, 29years old, asked second opinion about established diagnosis and treatment. Her complaints were high blood pressure, face edema, hyperglycemia, weight gain. She was on 22 week of gestation. Anamnesis was notable for AI, which was diagnosed few years ago. Before pregnancy she took 50 mg of hydrocortisone per day. When she became pregnant, the dose was increased to100 mg/day because of fatigue and dizziness. From that moment her condition worsened. She was seen by obstetrician, endocrinologist. Preeclampsia and gestational diabetes were suspected, antihypertensive drugs and insulin were prescribed. Patient was not sufficient with recommendations and asked about second opinion. Firstly, she had AI with treatment by supraphysiological doses of hydrocortisone, secondly, complaints developed after increased doses in first trimester, when preeclampsia is not possible to happen. Diagnosis of iatrogenic hypercortisolism was established. The dose of hydrocortisone was gradually decreased to 25 mg/day, her condition became better in a few days. Insulin, hypotensive drugs were stopped. In one month complaints disappeared. Her obstetrician was consulted by experienced endocrinologist about details of delivery and postpartum in women with AI.

Conclusion: In the first trimester treatment of AI may be difficult because symptoms of AI are seen in pregnancy. It is easy to assign insufficient doses. At the same time, clinics of iatrogenic hypercortisolism is similar to preeclampsia, the risk of overdose is high. Because of absence of clinical guidelines, doctors must strictly follow to existing recommendations in order to avoid such mistakes.