Endocrine Abstracts

Introduction: Adrenal insufficiency is rarely diagnosed during pregnancy. In the absence of treatment it is associated with high maternal-foetal morbidity and mortality. We report the case of a twenty-one years old female patient, diagnosed with adrenal insufficiency during a diabetic pregnancy of 12 weeks of gestation.

Observation: Twenty-one years old female patient, diagnosed with type 1 diabetes since the age of 15, Referred to our department for the follow-up of her diabetes with an unplanned, evolving pregnancy estimated at 12 weeks of gestation. The patient reported multiples episodes of hypoglycemia reaching 0.42 g/l and persistent asthenia. The clinical examination showed a blood pressure of 100/68 mmHg, heart rate of 71 bpm, and BMI of 22.86 kg/m². Suspicion of adrenal insufficiency is confirmed by a low baseline cortisol of 13 μg/dl for an average of 25.1 μg/dl according to the term (12 weeks of gestation). The patient initially received hydrocortisone 30 mg/d reduced after to 20 mg/d with a favorable evolution after the replacement therapy. Adrenal insufficiency of autoimmune cause in the context of autoimmune polyendorcrinopathy, is the most likely etiological diagnosis. The results of the etiological investigation are in progress.

Conclusion: Adrenal insufficiency can occur during pregnancy and be life-threatening if not treated appropriately. However with a correctly adapted hormonal substitution during pregnancy the evolution is favorable in most cases. During delivery, the treatment must be increased and administered by injection as during surgery. The diagnosis can sometimes be difficult due to confusion with the signs of pregnancy or in case of association with diabetes which could be responsible for a delayed management.