Clinico-pathological conference (CPC): adrenal insufficiency due to chronic granuloma¬tous infiltration with caseous necrosis

Abstract

We present the case of a 39-year-old woman who came to Hospital Universitario San Vicente de Paúl (HUSVP), in Medellín, Colombia, on July 29, 2010, around the 28th week of her first pregnancy, because of upper abdominal pain during the last 20 days. She had suffered from an ostium secundum atrial sept deffect that was surgically corrected on July 20, 2009. A mild prolapse of the mitral valve was also present. On admission, she was found to have uterine activity for which she had been treated with different drugs, during 13 days, at another institution; medication to induce fetal lung maturation had also been administered. During her hospital stay diagnoses of gestational diabetes and non-immune fetal hydrops were made. At HUSVP she continued to have uterine irritability and abdominal pain, and developed tachycardia and tachypnea. On the third day of stay in the ICU she had a difficult vaginal delivery requiring the use of forceps. After childbirth, she experienced pain in the back and hemodynamic collapse. Despite vasopressor treatment with norepinephrine and vasopressin, she remained acidotic, hypotensive and bracycardic, and died.