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Case Reports
. 2022 Sep 14:9:891101.
doi: 10.3389/fmed.2022.891101. eCollection 2022.

Adrenal crisis during pregnancy: Case report and obstetric perspective

Barbara Gardella  1   2 , Andrea Gritti  1   2 , Annachiara Licia Scatigno  1   2 , Anna Maria Clelia Gallotti  3 , Francesca Perotti  1   2 , Mattia Dominoni  1   2
Affiliations
Case Reports

Adrenal crisis during pregnancy: Case report and obstetric perspective

Barbara Gardella et al. Front Med (Lausanne). .

Abstract

Adrenal dysfunction (AD) and, in particular, adrenal crisis are uncommon events in pregnant women, but associated with significant maternal and fetal morbidity and mortality if untreated or undiagnosed. Adrenal crisis may be confused with the common symptoms of pregnancy: the obstetricians should be able to promptly diagnose and treat it in order to avoid the adverse outcomes regarding the mother and the fetus. For this reason, AD must be treated by an expert multidisciplinary team. We presented a case report of a young pregnant woman with adrenal crisis due to tuberculosis, cocaine abuse, and massive bilateral hemorrhage with symptoms of emesis, hypotension, sudden abdominal pain, and leukocytosis. The most common issues of diagnosis and treatment are discussed and analyzed. Finally, we performed a review of the literature regarding adrenal crisis and adrenal insufficiency (AI) in pregnancy in order to clarify the management of these diseases in obstetrics setting.

Keywords: adrenal crisis; adrenal gland; adrenal insufficiency; obstetric; pregnancy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
A representative image of adrenal glands with computed tomography. The axial un-enhanced computed tomography performed at time 0 shows enlarged and ill-defined adrenal glands and fluid film with a mean density of 50 Hounsfield Unit.
FIGURE 2
FIGURE 2
A representative image of adrenal glands with magnetic resonance imaging. T2 axial view at time 0 confirmed enlarged adrenal glands with hyperintense signal due to hyperacute hemorrhage. No focal lesions were described.
FIGURE 3
FIGURE 3
A representative image of adrenal glands with magnetic resonance imaging. The marked hypointensity signal confirmed the presence of adrenal hemorrhage.
FIGURE 4
FIGURE 4
A representative image of adrenal glands with magnetic resonance imaging. After 4 weeks, the adrenal glands show normal shape, margins, and signal intensity in T2 axial view images. The film fluid was resolved.
FIGURE 5
FIGURE 5
Flow-chart of management of adrenal crisis in pregnancy.
See this image and copyright information in PMC

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