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Addison's disease in the peripartum period, three case reports
  1. M MacDougall,
  2. S Adair,
  3. R Nayar
  1. Sunderland Royal Hospital, Sunderland, UK

Abstract

Objective the authors discuss three cases of Addison's disease of peripartum onset

Methods The authors review the clinical, radiological and biochemical investigations which lead to their diagnosis and discuss both the impact of the condition on the pregnancy and the pregnancy on the condition.

Results Case 1: a 19 year old P0+1 with a family history of thrombophilia, who at 33 weeks in a dichorionic diamniotic twin pregnancy developed a metabolic acidosis associated with sepsis. Although her fever responded to antibiotics the acidosis persisted necessitating delivery. Her short synachthen test was flat and unresponsive and acute Adesonian crisis was diagnosed. Clinical improvement followed the administration of replacement steroid hormones. Case 2: a 21 year old P0+0 who was diagnosed intrapartum with Addison's disease following a protracted period of feeling unwell, associated with lethargy, dizziness and loss of appetite. She was hyponatraemic and suffered from postural hypotension. A low serum cortisol was demonstrated, Addison disease was diagnosed, and following fluid resuscitation and steroid replacement she went on to have a normal pregnancy. Case 3: a 28 year old P1+0 who developed an acute Adesonian crisis following the preterm delivery of her first child. During her current pregnancy she has had episodes of hyponatraemia, and postural hypotension, all of which responded to changes in her steroid hormone replacement therapy.

Conclusion While Addison's disease in pregnancy is rare and potentially life threatening, to both mother and fetus, early diagnosis and aggressive management can help to avoid serious complications for both.

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