Acute Adrenal Insufficiency During Pregnancy and Puerperium: Case Report and Literature Review

Perlitz, Yuri; Varkel, Jacob; Markovitz, Jakob; Ami, Moshe Ben; Matilsky, Moshe; Oettinger, Moshe

doi:10.1097/00006254-199911000-00023

Cited by 15 publications

(10 citation statements)

References 16 publications

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“…Disease severity is dependent on the degree of anterior pituitary dysfunction, and SS usually develops months to years after pregnancy (2). Acute presentations caused by circulatory collapse and hypoglycemia are less common (2,(5)(6)(7). Agalactia is the most common symptom in the postpartum period, and MRI is useful in distinguishing SS from lymphocytic hypophysitis (4).…”

Section: Discussionmentioning

confidence: 99%

Sheehan Syndrome Associated With Raised Intracranial Pressure

Moodley

Broad

Chung

et al. 2013

Journal of Neuro-Ophthalmology

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Section: Discussionmentioning

confidence: 99%

Sheehan Syndrome Associated With Raised Intracranial Pressure

Moodley

Broad

Chung

et al. 2013

Journal of Neuro-Ophthalmology

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“…To ensure evaluation of cases in the context of modern treatment, only cases dating 1976 onward were considered for inclusion (8,20,26,27,28,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52). This search identified 28 cases of primary AI, a case series with 17 cases of treated adrenocortical carcinoma patients, out of which 7 were included as they were on hydrocortisone treatment following surgical treatment (51) PAI (5) Y (2/5)…”

Section: Fertility and Preconceptional Considerationsmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Fertility, pregnancy and lactation in women with adrenal insufficiency

Anand

Beuschlein

2018

European Journal of Endocrinology

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With the introduction of hormonal substitution therapy in the 1950s, adrenal insufficiency (AI) has been turned into a manageable disease in pregnant women. In fact, in the light of glucocorticoid replacement therapy and improved obstetric care, it is realistic to expect good maternal and fetal outcomes in patients with AI. However, there are still a number of challenges such as establishing the diagnosis of AI in pregnant women and optimizing the treatment of AI and related comorbidities prior to as well as during pregnancy. Clinical and biochemical diagnoses of a new-onset AI may be challenging because of overlapping symptoms of normal pregnancy as well as pregnancy-induced changes in cortisol values. Physiological changes occurring during pregnancy should be taken into account while adjusting the substitution therapy. The high proportion of reported adrenal crisis in pregnant women with AI highlights persistent problems in this particular clinical situation. Due to the rarity of the disease, there is no prospective data-guiding management of pregnancy in patients with known AI. The aim of this review is to summarize the maternal and fetal outcomes based on recently published case reports in patients with AI and to suggest a practical approach to diagnose and manage AI in pregnancy.

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“…12 An early morning cortisol blood sample of <100 nmol/L is diagnostic of adrenal insufficiency, whereas a cortisol value of >500 nmol/l is normal. 14 The cortisol level in a pregnant woman is about three to five times that of a non-pregnant female.…”

Section: Managementmentioning

confidence: 99%

“…14 The cortisol level in a pregnant woman is about three to five times that of a non-pregnant female. 12 Management consists of replacing the affected hormones 13 ; for example, thyrotropin deficiency needs l-thyroxin. In women with severe pan-hypopituitary crisis, it is important to give intravenous hydrocortisone initially with a high dosage of 100-150 mg hydrocortisone three times daily.…”

Section: Managementmentioning

confidence: 99%

Underlying medical conditions

Lombaard

Pattinson

2008

Best Practice & Research Clinical Obstetrics & Gynaecol

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More than half of maternal deaths in the UK are due to pre-existing medical conditions, and medical emergencies often mimic acute obstetric conditions. An acute flare of systemic lupus erythaematosus, a thyroid storm or a phaeochromocytoma have many of the signs and symptoms of imminent eclampsia. Similarly, severe postpartum haemorrhage can result in diagnostic difficulties of medical conditions such as Addison's syndrome or acute renal failure. An acute collapse can be due to a pulmonary embolus, myocardial infarction, tachyarrhythmia or myasthenia gravis. These conditions are rare; however, unless they are considered in a differential diagnosis, they will not be diagnosed, to the detriment of the woman and her infant. This chapter deals with acute medical conditions occurring uncommonly in pregnant women. An obstetrician should know the initial steps to take in the emergency management of these cases.

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Acute Adrenal Insufficiency During Pregnancy and Puerperium: Case Report and Literature Review

Abstract: After completion of this article, the reader will be able to understand the various presentations of hypopituitarism, the various etiologies of this condition, and the appropriate work up and management of a patient with hypopituitarism.

Cited by 15 publications

References 16 publications

Sheehan Syndrome Associated With Raised Intracranial Pressure

Sheehan Syndrome Associated With Raised Intracranial Pressure

MANAGEMENT OF ENDOCRINE DISEASE: Fertility, pregnancy and lactation in women with adrenal insufficiency

Underlying medical conditions

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