title: Acute adrenal insufficiency during pregnancy and puerperium: case report and literature review.
abstract: Acute adrenal dysfunction during pregnancy is rare. Nevertheless, adrenal insufficiency can present as an adrenal crisis, and may be life threatening. There is a wide range of clinical symptoms and signs, and the differential diagnosis is challenging. A full adrenal and pituitary evaluation, both structural and hormonal, must be performed to reach the correct diagnosis, and appropriate treatment must not be delayed. A case is presented of acute adrenal insufficiency that occurred 24 hours after a cesarean delivery. The initial symptoms included hypoglycemic seizures and coma. The workup, both hormonal and structural, revealed isolated adrenocorticotrophic hormone deficiency. This considers this case and reviews the differential diagnosis, diagnostic workup, and the treatment of adrenal dysfunction in pregnancy and the puerperium, as well as the obstetric outcome in women suffering from this disorder.
  
  
  BACKGROUND
  Obstetricians & Gynecologists, Family Physicians.
  
  
  OBJECTIVE
  After completion of this article, the reader will be able to understand the various presentations of hypopituitarism, the various etiologies of this condition, and the appropriate work up and management of a patient with hypopituitarism.
authors.affiliation: Department of Obstetrics and Gynecology, Poriya Government Hospital, Hagalil Hatachton, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Perlitz
authors.forename: J
authors.initials: J
authors.lastname: Varkel
authors.forename: J
authors.initials: J
authors.lastname: Markovitz
authors.forename: M
authors.initials: M
authors.lastname: Ben Ami
authors.forename: M
authors.initials: M
authors.lastname: Matilsky
authors.forename: M
authors.initials: M
authors.lastname: Oettinger
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis / Q000209:etiology*; D000324:Adrenocorticotropic Hormone / Q000172:deficiency*; D000328:Adult; D003128:Coma / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000503:physiopathology*; D012640:Seizures / Q000209:etiology
chemical_list: D000324:Adrenocorticotropic Hormone