Endocrine Abstracts

Introduction: In pregnant women, diagnosis of adrenal insufficiency is particularly difficult as signs and symptoms of hypoadrenalism such as nausea and fatigue may mimic normal gestational changes. Investigations for adrenal insufficiency in pregnancy are also complicated due to effects of pregnancy on HPA axis. We therefore present a case report of adrenal insufficiency diagnosed during pregnancy.

Case: Endocrine consultation was requested for a 29-year-old Caucasian woman with 18 weeks gestation who had recurrent hospital admissions with hyperemesis and hyponatremia. The patient was readmitted to hospital two days after finishing a tapering course of prednisolone prescribed for hyperemesis. She was noted to have significant skin tanning, hyponatremia and previous history of Grave’ disease. An urgent short synacthen test (SST) was performed, and she was prescribed replacement doses of hydrocortisone. Her SST showed baseline cortisol of 205nmol/l and 177nmol/l at 30 minutes, with ACTH level of 43ng/l. Her adrenal antibodies were subsequently recorded as elevated.

Conclusion: Pregnancy induces a rise in CBG and total cortisol, particularly in the third trimester, affecting SST interpretation. Standard cortisol cutoffs may not apply, and trimester-specific thresholds remain invalidated. Clinical judgment, supported by careful interpretation of the diagnostic tests remains essential. Early recognition and steroid replacement are key to preventing complications. Adrenal insufficiency should be considered in pregnant women with unexplained hyperemesis, hyponatraemia, or hyperpigmentation. SST can be used cautiously, but results must be interpreted in the context of pregnancy-related physiological changes. Timely diagnosis and management are critical for optimal maternal and fetal outcomes.