An Unusual Case of Transient Cortisol Deficiency and Profound Hyponatremia in a Pregnant Female with Pre-Eclampsia

Dr.Khalid Farooqui, Dr.Hassan Abuzaid, Dr.Joyal Mathew, Dr.Farah Farooqui, Dr.Naseera Abubaker

Pre-eclampsia is a multisystem disorder that complicates 3-8% of pregnancies and accounting 18% of maternal deaths. Pre-eclampsia is defined as hypertension and proteinuria with associated signs and symptoms such as pedal edema, headache, visual disturbances, and epigastric pain which starts at the onset of 20 weeks of pregnant state. Usually in pre-eclampsia we found no electrolyte disturbances except lower levels of magnesium in most of the cases. Pre-eclampsia with profound hyponatremia is one of the rare complications encountered during pregnancy and as per the literature we found only 14-16 cases have been reported. In such situation patient may predispose to convulsions, maternal mortality and fetal damage. Normally pregnancy is a state of hypercortisolemia (glucocorticoid excess) particularly in the latter stages and testing of HPA axis (hypothalamic-pituitary-adrenal axis) using validated stimulation or confirmation test during pregnancy are lacking. Adrenal insufficiency in pregnancy is relatively rare with reported incidence of 1:3,000 births and it is associated with significant maternal and fetal morbidity if untreated during gestation or in the puerperium. Pregnancy induced metabolic and endocrine changes with related symptoms is difficult to recognize, and a challenge to confirm the diagnosis of cortisol deficiency. Clinical features such as excessive dizziness, syncope, nausea, protracted vomiting, weight loss, profound hyponatremia, hypoglycemia and salt craving should raise the suspicion of Adrenal insufficiency. We report a rare case admitted with history of dizziness, headache and abdominal pain found to have profound hyponatremia in 3rd trimester of pregnancy with pre-eclampsia and transient cortisol deficiency.

https://doi.org/10.31871/WJRR.8.2.16