Adrenal crisis, though rare during pregnancy, poses a significant challenge in diagnosis due to physiological changes in adrenocorticotrophin (ACTH) production and cortisol binding. Non-haemorrhagic adrenal infarction (NHAI) is a rare complication of pregnancy (1.3% of flank pain), with symptoms mimicking other common pregnancy-related issues.

Menon et al. report the case of a 36-week pregnant 25-year-old woman presenting with severe left flank pain, hypotension (111/65mmHg), tachycardia (129bpm), hypoglycaemia (3mmol/l), and hyponatraemia (125mmol/l). Despite intravenous fluids, antibiotics and glucose, she continued to deteriorate.

A computed tomography pulmonary angiogram was negative for a pulmonary embolism, but showed an incidental left adrenal mass (1.9cm). ACTH (220.8ng/l) and 09.00am cortisol (212nmol/l) confirmed adrenal insufficiency, and she was promptly treated with steroid replacement. She went on to have a successful birth (induction at 38+5 weeks) and resolution of adrenal insufficiency (16 months postpartum, short synacthen test 634nmol/l). An abdominal magnetic resonance imaging scan post-birth was consistent with NHAI.

Diagnosing adrenal insufficiency during pregnancy is challenging but crucial. NHAI, though rare, should be considered in abdominal pain presenting in pregnancy. The case highlights the importance of vigilance in diagnosing and managing adrenal crises during pregnancy.

Read the full article in Endocrinology, Diabetes & Metabolism Case Reports EDM-23-0093 https://doi.org/10.1530/EDM-23-0093