Endocrine Abstracts

A 25-year-old primi 26 weeks pregnant was admitted with B/L flank pain & pleuritic sounding chest pain. She was septic on initial assessment by the Obstetric team and preliminary investigations revealed high inflammatory markers, raised CRP of 336 & deranged LFT’s. Her USS scan suggested possible hepatitis/cholangitis and blood cultures grew E. coli & she was started on IV Ceftriaxone & metronidazole for the same. At day 3 of her admission, she started deteriorating clinically with fluid responsive hypotension, tachycardia and generally unwell with an episode of hypoglycemia. She had stopped spiking temps by then & her CRP had improved to 151. Because of the initial suspicion of PE, she underwent an urgent low dose CTPA to rule out a massive PE causing hypotension which was negative for VTE. It did however suggest B/L bulky adrenals. She subsequently went on to have an MRCP the same due to worsening LFTs which was negative for obstructive jaundice but again suggested a possibility of B/L bulky adrenals. Her scans were reviewed in the Urology MDT and a possibility of B/L Adrenal Hemorrhage was suggested. Her 9 am cortisol was 177. She was given IV Hydrocortisone 100 mg iv and was started on Oral hydrocortisone replacement which improved her BP & settled her tachycardia. She then had a dedicated MRI Adrenal scan which confirmed T2 hyper intensities in B/L Adrenal glands suggestive of B/L Adrenal Hemorrhage. Further workup was negative for Adrenal Antibodies & Autoimmune screen including Antiphospholipid Antibodies. She completed her 10-day course of IV Antibiotics for E. coli & was discharged on maintenance Hydrocortisone replacement for her Adrenal Insufficiency with a SST planned after her pregnancy to reevaluate her Adrenal reserve. Her baby thankfully remained stable throughout her torrid clinical course. This case was interesting as Adrenal Hemorrhage is usually described in the context of Meningococcal infections & there are only few reported cases of Adrenal Hemorrhage in pregnancy causing Adrenal Crisis.