EC Gynaecology

Background: Primary adrenal insufficiency is a rare endocrine disorder characterized by deficient cortisol production, with or without aldosterone deficiency, and carries a significant risk of adrenal crisis during pregnancy due to increased physiological stress demands. This case aimed to highlight the diagnostic and therapeutic challenges of managing adrenal insufficiency complicated by recurrent infection during pregnancy.

Case Report: A 39-year-old gravida 4 para 3+0 African woman with known primary adrenal insufficiency presented twice during pregnancy with recurrent multidrug-resistant septic illness. At 29+3 and 32 weeks of gestation, she developed fever, dysuria, respiratory symptoms, and systemic inflammatory features consistent with sepsis. Investigations revealed elevated inflammatory markers, electrolyte imbalance, and multidrug-resistant urinary infection. She was managed with intravenous antibiotics, intensive monitoring, and escalation from oral to stress-dose intravenous hydrocortisone (50 mg every 6 hours), with multidisciplinary input from obstetrics, endocrinology, and infectious disease teams. An elective cesarean section with bilateral tubal ligation was performed at 37 weeks under perioperative steroid coverage. Maternal recovery was uneventful, and a healthy 2.8 kg neonate was delivered.

Conclusion: This case highlights that early recognition and prompt stress-dose steroid therapy are critical in preventing adrenal crisis during pregnancy. Recurrent infection significantly increases physiological stress and risk of endocrine decompensation. Multidisciplinary management is essential to optimize maternal and foetal outcomes.

Keywords: Primary Adrenal Insufficiency; Addison Disease; Pregnancy; Adrenal Crisis; Sepsis; Hydrocortisone; Multidisciplinary Care

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