Endocrine Abstracts

A 33-year-old woman with type 1 diabetes and autoimmune Addison’s disease conceived in September 2021 following careful preconception counselling. The patient had a history of recurrent, severe hypoglycaemia requiring intensive care admission and had previously received two allogenic islet cell transplants (January 2020 and November 2020). The patient had no severe hypoglycaemia following transplantation, although she continued to experience overnight hypoglycaemia, while in a steroid deficient state. Total daily dose of insulin required post-transplantation was <10 units. The pregnancy was complicated by hyperemesis and recurrent adrenal crises, despite careful monitoring of glucocorticoid and mineralocorticoid replacement. Tacrolimus was continued throughout the pregnancy as immunosuppressive therapy, with escalating doses required for therapeutic effect. Crucially, from 18 weeks of pregnancy, when women with diabetes typically experience rising insulin resistance because of placental hormone production, this patient’s insulin requirements did not increase. Overnight hypoglycaemia in the context of autoimmune Addison’s disease remained a clinical concern. C-peptide secretion was measured throughout each trimester and did not significantly change across the course of the pregnancy (latest biochemistry results pending). In the third trimester, the patient developed pre-eclampsia. This complication occurred in the setting of an apparently ’normal’ blood pressure: a consequence of mineralocorticoid depletion and her medical comorbidities. A Caesarean section was performed at 35 + 3 weeks. The neonate developed severe hypoglycaemia and required ventilation during the first day of life. Both mother and baby recovered quickly and were discharged home one week later. This case illustrates a complex pregnancy with a successful outcome in the rare and challenging setting of type 1 diabetes with islet cell transplantation and concurrent Addison’s disease. Importantly, biochemical surveillance reveals that the function of the transplanted islet cells has not been negatively impacted upon by the profound insulin resistance of pregnancy.