Adrenal Insufficiency in Pregnancy: A Rare but Easily Overlooked Emergency in Obstetric Practice

Abstract

Background: Adrenal insufficiency during pregnancy is a unique occurrence in obstetric practice. The symptoms of adrenal insufficiency mimic the physiologic effects of pregnancy and is associated with poor maternal and foetal outcomes. Case: This is a case report of a 34-year-old African woman, G6P4 +1SA at about 21 weeks gestation, non-antenatal care attendant who was admitted to the hospital for sudden onset of bleeding per vaginum and confusion. Notable findings were refractory hypoglycemia, hypotension, hyponatremia, and low levels of serum cortisol and ACTH. She was diagnosed with a possible central adrenal insufficiency and made substantive clinical improvement on steroid replacement therapy, until a miscarriage at about 25 weeks gestation. Conclusion: There is a paucity of literature on the diagnosis and management of adrenal insufficiency during pregnancy in Ghana. Due to its similarity with normal pregnancy symptoms, adrenal insufficiency can easily be missed in routine obstetric practice.  A high index of suspicion as well as a multidisciplinary team approach is essential to improve maternal and foetal outcomes.