Persistent Fatigue After Pregnancy: A Case Report

Abstract Background: Pregnancy is characterized by physiologic immunosuppression and the postpartum period often associated with rebound autoimmunity leading to unmasking of latent autoimmune disorders. Clinical Case: A thirty-one-year-old Caucasian female presented generalized fatigue, myalgias arthralgias that started three months after birth her first child. She was seen at a local hospital on multiple occasions treated symptomatically. noted have orthostatic hypotension during these visits initiated midodrine fludrocortisone for presumed postural tachycardia syndrome. When symptoms did not abate, she referred our center further care. At time we saw her, reported nausea vomiting in addition aforementioned symptoms. On careful questioning also admitted salt craving unintentional weight loss about 20 lbs over past months. history or endocrine disorders, but family positive Grave’s disease celiac aunt mother respectively. Physical examination revealed hyperpigmentation face, knuckles, toes abdominal scars. Random serum cortisol level low (1.06 mcg/dL) no perceptible response ACTH stimulation (1.10 mcg/dL 1.04 30 60 mins respectively). Serum aldosterone undetectable (<4 ng/dL) dehydroepiandrosterone sulfate (19 mcg/dL, n: 45–295 mcg/dL). The patient immediately corticosteroid replacement therapy. Her rapidly resolved discharged maintenance dosing hydrocortisone fludrocortisone. grossly elevated (577 pg/mL) 21-Hydroxylase antibodies were positive, confirming diagnosis adrenalitis. Conclusion: Symptoms adrenal insufficiency are non-specific can overlap physiological pregnancy. Persistence delivery should raise concerns adrenalitis precipitated immune reconstitution period.