Management considerations in Addison’s disease complicating pregnancy

Addison’s disease is a rare endocrine disorder. We present the management of a pregnant lady with Addison’s disease. She was managed jointly with the endocrinologists and the titrated dose of hydrocortisone and fludrocortisone dosage was regulated. Her antenatal care was uneventful and she had emergency caesarean section at 39 weeks in view of abnormal CTG. Her labour was appropriately covered with rescue steroids. However she went into hypotension immediately after delivery. She was resuscitated and was managed further in ICU where high dose steroids were given. She made an uneventful recovery. 1. Management of pregnancy with Addison's disease is challenging but are often achieved with appropriate multidisciplinary management; 2. Patients with Addison's disease tolerate pregnancy well if the replacement steroids are adjusted and monitored closely; 3. Labour and delivery need to be managed cautiously with adequate steroid replacement to ensure successful outcomes; 4. Differentials need to be considered when adequate steroid cover has been provided and still there is a picture of Addisonian crisis.