What is the materno-fetal prognosis of adrenal insufficiency and pregnancy in low ressource setting ? A case report

Abstract

Introduction and importance: Adrenal insufficiency is a rare chronic disease with a prevalence of 39 to 60 cases per million peoples in Europe. However, the prevalence is higher in sub-saharian Africa. The occurrence of pregnancy in adrenal insufficiency is rare but associated with high maternal and perinatal morbidity and mortality. For this reason, the management of pregnancy in adrenal insufficiency patient must be provided by a multidisciplinary team. Case presentation: We report the case of a 34-year-old pregnant woman followed for adrenal insufficiency secondary to prolonged corticosteroid therapy. Treatment consisted to an obstetrical and endocrinological follow-up and corticosteroid replacement therapy with hydrocortisone. A prophylactic caesarean section at 38 weeks resulted in the birth of a newborn male weighing 3395g. Maternal and perinatal prognosis was good. Clinical discussion: Pregnancy in adrenal insufficiency is a therepeutic challange in developing countries. Through this case, we discuss the therapeutic and prognostic aspects of adrenal insufficiency in our setting. Conclusion: With the introduction of gluco-corticosteroid replacement therapy, pregnancy in adrenal insufficiency can progress normally.