Endocrine Abstracts

Case Presentation: A 29-year-old G2 P0 woman at 8weeks of gestation presented with hyperemesis gravidarum and electrolyte imbalance (hyponatremia and hyperkalemia). Despite copious intravenous fluid resuscitation and antiemetics, her symptoms persisted. Notable clinical findings included generalized tanning, postural hypotension, and vomiting, led to a suspicion of adrenal insufficiency.

Endocrine evaluation revealed:

• Random Cortisol: 181 nmol/L

• Sodium: 114 mmol/L (Normal: 133-146 mmol/l)

• Potassium: 6.1 mmol/L (Normal: 3.5-5.3 mmol/l)

• Adrenal Cortex Antibodies: Positive

Short Synacthen Test

• 0 Minute Basal Cortisol: 208 nmol/L

• 30 Minute Cortisol: 211 nmol/L

• 60 Minute Cortisol: 203 nmol/L

• Plasma ACTH: 1298 ng/L (elevated) Up to 50ng/L

These findings confirmed the diagnosis of Addisonian crisis. The patient was treated with glucocorticoid therapy, resulting in marked symptom improvement. She was followed up in the endocrine clinic, continued on hydrocortisone, and started on oral fludrocortisone for postural hypotension.

Discussion: The Early Pregnancy Unit did not initially consider adrenal Insufficiency due to symptom overlap with hyperemesis gravidarum, a common condition in early pregnancy. Both conditions cause nausea, vomiting, and dehydration, complicating the diagnostic process. Pregnancy-related physiological changes, such as increased metabolic demand and stress responses, can unmask or exacerbate adrenal insufficiency, triggering a crisis. This patient had a history suggesting that she may have had adrenal insufficiency for at least one year before the pregnancy. Awareness of signs like unexplained tanning is crucial for early detection as in this case.

Conclusion: This case emphasizes the importance of early recognition of adrenal insufficiency in pregnancy. Prompt referral to an endocrinologist can prevent complications and ensure optimal treatment, improving outcomes for both mother and fetus. This case highlights the intersection of obstetrics and endocrinology Multi-Disciplinary Team in managing complex pregnancy-related conditions.