ECE2017 Eposter Presentations: Adrenal and Neuroendocrine Tumours Clinical case reports - Pituitary/Adrenal (32 abstracts)
Primary adrenal insufficiency and pregnancy – a case report
Slavica Savic 1 , Mirjana Stojkovic 1, , Biljana Nedeljkovic-Beleslin 1, , Tanja Nisic 1 , Milos Stojanovic 1, , Marija Miletic 1 , Jasmina Ciric 1, , Svetlana Spremovic-Radjenovic 2, & Milos Zarkovic 1,
1Clinic of Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia; 2School of Medicine, University of Belgrade, Belgrade, Serbia; 3Clinic for Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia.
Primary adrenal insufficiency (PAI) is uncommon in pregnancy. Women with PAI have reduced fertility and parity. If unrecognized or untreated during pregnancy PAI increases risk for maternal and foetal morbiditiy and mortality. Majority of women diagnosed before conception and appropriately treated, have uneventful pregnancies, with increased risk of cesarean section (CS) and preterm delivery.
We report a 38-year-old woman with PAI during first spontaneus pregnancy.
The patient was diagnosed with Addison’s disease at the age of 17, and hyperthyroidism 14 years later. Her family history revealed hyperthyroidism in mother. She had regular menstrual pattern and no pregnancy during 5 years of marriage. Gynecological investigation was unremarkable, but she had addisonian crisis during hysterosalpingography 6 months before conception. At that time she was taking 30 mg hydrocortisone, 0.1 mg fludrocortisone and 50 mcg levothyroxine/daily. At 8 weeks of pregnancy she started to complain of fatigue, dizziness and palpitations, with no nausea or vomiting. Physical examination was unremarkable, BP 100/70 mmHg, with no orthostasis or discolouration of skin/mucous membranes. Oral progesterone was started because of spotty vaginal bleeding and in 2 weeks she developed mild hyponatraemia. We recommended to split hydrocortisone in four doses, and increased fludrocortisone to 0.125 mg. During second trimester she was stable, plasma electrolytes and thyroid function test were normal, with no foetal or placental abnormalities on ultrasonography. In the middle of the third trimester hydrocortisone and fludrocortisone doses were further ajusted to 35 mg and 0.15 mcg respectively. She underwent CS at the 39th gestational week and a healthy baby girl weighing 3250 g was delivered. During the 15-month follow-up period mother and baby were in good condition.
We presented a case of women with autoimmune polyglandular syndrome (APS 2) and succesful pregnancy outcome. Women with PAI should be monitored by a multidisciplinary team throughout pregnancy to ensure maternal and foetal health.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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