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Endocrine Abstracts (2014) 35 P31 | DOI: 10.1530/endoabs.35.P31

1Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey; 2Department of Internal Medicine, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey; 3Department of Biochemistry, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey.

Introduction: We report a case with primary adrenocortical deficiency after the first month of lactation.

Case report: Thirty-year-old woman was referred with complaints including dizziness, weakness and fatigue in the early postpartum and lactation period. On physical examination, weight 63 kg, height 164 cm, blood pressure 100/65 mmHg, pulse 96 per min were detected. She had the increase of the brown pigmentation on her hands and face. In the analyzes of the blood, fasting blood glucose 91 mg/dl (70–100), creatinine 0.8 mg/dl (0.5–1.2), potassium 4.9 mmol/l (3.5–5.5), sodium 139 mmol/l (132–146), aspartate transaminase 25 U/l (0–34), alanine transaminase 25 U/l (10-49), prolactin 123 ng/ml, LH 5.25 mIU/ml FSH 6.63 mIU/ml, estradiol 37.7 pg/ml, free T4 0.86 ng/dl (0.54–1.24), TSH 2.89 IU/ml (0.34–5.6), cortisol 1.9 ug/dl (6-7-22,6), dehydroepiandrosterone sulfate <15 g/dl (35–430), ACTH 1453 pg/ml (7.2–63.3), the plasma renin 4.5 pg/ml (5.4–34.5), aldosterone <20 pg/ml were determined. The estimated primary adrenocortical insufficiency in patients, there was no response to the test Cosyntropin (peak cortisol levels was 2.15 μg/dl). Autoantibodies in autoimmune polyglandular involvement in terms antipariyetal antibodies were positive only. Adrenal imaging showed no pathology. Chest-X-ray and tuberculin skin test were negative. After saline infusion followed by glucocorticoid and mineralocorticoid replacement therapy, she was recovered.

Discussion: During pregnancy and postpartum, the prevalence of primary adrenal insufficiency is unknown. Primary adrenocortical deficiency in the postpartum periods can be diagnosed and treated, carefully.

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