SFEBES2021 Poster Presentations Reproductive Endocrinology (31 abstracts)
Spontaneous adrenal haemorrhage and adrenal deficiency during third trimester – successful delivery with conservative management: A case report
Bhavna Sharma 1 , Mushtaqar Rahman 1 , Karim Meeran 2 , Shivshankar Seechurn 1 , Asjid Qureshi 1 , Elaine Hui 1 , Ian Seetho 1 & Mahesh Deore 1
1Northwick Park Hospital, London, United Kingdom; 2Imperial College NHS Trust, London, United Kingdom
A 33 year old white European patient presented at 32 weeks gestation with a three day history of severe epigastric pain radiating to left flank with vomiting. She had pre-existing hypertension, controlled with labetalol. On admission, her BP dropped from 170/100mmHg to 90/70mmHg. Abdominal examination revealed epigastric tenderness without peritonism. There were no Cushingoid features. An abdominal ultrasound scan was normal. An MRI scan showed a bulky left adrenal gland, with appearances of recent haemorrhage; the right adrenal was normal. Of note, no adrenal abnormality was seen in an MRCP 5 years previously. Inflammatory markers were raised, but platelet count normal; amylase 69IU/l; plasma sodium 130 mmol/l , potassium 4.5 mmols/l; normal renal profile; urine sodium 55 mmol/l; thrombophilia screen negative. A 9 am plasma cortisol was very low, 40 nmol/l, with undetectable ACTH; adrenal antibodies negative. A 24-hour urine metanephrine profile was unremarkable: metanephrine < 56 nmol/l, normetanephrine 2076 nmol/24 hours, and 3-methoxytyramine 1025nmol. Plasma metanephrine profile was also normal: metadrenaline < 37.5 pmol/l, normetadrenaline 419.7 pmol/l, 3-methoxytyramine < 75pmol/l. Echocardiography was normal. The clinical picture suggested suppression of the adrenal axis by a cortisol-producing adrenal tumour, but with spontaneous haemorrhage into it. The biochemical findings predated any obstetric use of betamethasone. She was commenced on PO hydrocortisone 25 mg per day and remained well throughout gestation. Hydrocortisone 100 mg IM was given at vaginal delivery. There were no neonatal or perinatal complications. Our case represents a rare presentation of probable Cushing’s syndrome in pregnancy, which is usually due to an adrenal adenoma. We hypothesise that our patient may have had secondary haemorrhagic transformation following ischaemic infarction of the adenoma. Further MRI scanning and endocrine tests are planned post-partum.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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