Manage Addison s pregnant patient with appropriate education

Background and Aim : Addison s disease (AD) is a rare condition in pregnancy. Adrenal crisis (AC) islife-threatening event in pregnant women that requiring immediate management. Regular education andclinical findings are very important to the patient and partner/caregiver to avoid complications and toreceive good outcomes, especially in the management of emergency AC. A case report of a 34-year-oldwoman with Addison s disease that after 7 years of infertility, became pregnant without induction ofovulation. In the prenatal period, the patient received regular education. At 38/70 weeks, cesarean sectionwas performed due to breech presentation and labor pain. Finally, a healthy girl was born with a goodAPGAR score and weight of 2620 g. The purpose of the present study is the education to pregnant womenwith the Addison’s disease and partner/caregiver in the management of AD, especially emergency AC.Methods : A 34-year-old woman with Addison s disease who was diagnosed two years ago. The patienthas been hospitalized several times in childhood and adulthood due to hypotension, nausea, vomiting andabdominal pain and has been under conservative control. After 7 years of infertility, person becamepregnant without induction of ovulation (2 years after AD treatment)Results : The patient was hospitalized at 36 weeks gestational age with a proteinuria of about 325 mg/24hours. After ruled out of preeclampsia, the patient was discharged. At 37/70 weeks, cesarean section wasperformed because of labor pain and breech presentation. Finally, a healthy girl was born with a weight of2620g, APGAR score in 1 and 5 minutes was 9/10. Before surgery, person received stress doses of cortisol.After delivery, stress dose of medication was adjusted and tapered because mother had no problem. After48 hr, the amount of drugs decreased to pre-pregnancy level.Conclusion : All adrenal insufficiency patients should have medical information card, glucocorticoid (100mg hydrocortisone or 4 mg dexamethasone), and normal saline (0.9%) for injection in emergencysituations. Finally, when referring a pregnant patient with AD, it is important to educate patient andpartner/caregiver about self-adjustment and self-injection of medicine, in addition to providing reassuranceand meditation to reduce stress.

کلیدواژه ها:

Education ، Addison s disease ، Pregnancy ، Adrenal crisis