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Adrenal crisis represents the major endocrine emergency with a fatal outcome if not properly recognized and correctly treated. It can present as the first manifestation of acute or chronic primary adrenal failure. Secondary adrenal insufficiency with usually less dramatic manifestations can cause mental disturbances, electrolyte or metabolic disorders severe enough to warrant prompt correction and therapeutic intervention. This is particularly true in cases of abrupt cessation of steroid treatment, pituitary apoplexy and Sheehan's syndrome. Hyperfunction of the adrenal cortex, be it hypercorticism or hypermineralocorticism, can also require rapid treatment of electrolyte disorders and hypertension. The symptoms and differential diagnosis of these entities are described as well as their proper treatment. In order to confirm later the diagnosis, the need to secure biological samples for hormone determination before starting treatment is emphasized.
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PMID:Endocrine emergencies. Disorders of the adrenal cortex. 173 96

Pituitary apoplexy in pregnancy is rare. Its clinical features may range from unspecific complaints to panhypopituitarism resulting even in coma and death. Therefore, alertness to signs and symptoms of acute loss of pituitary function in pregnancy is mandatory. We report a woman in her 7th week of her first gestation presenting with sudden coma due to severe hyponatremia. Secondary adrenal insufficiency could be identified as the underlying cause. Panhypopituitarism including central diabetes insipidus and spontaneous abortion developed during the follow-up. Magnetic resonance imaging showed pituitary apoplexy without a pre-existing pituitary mass. The clinical course was notable for severe complications, including neurological deficits through cerebral ischemia, but eventual recovery could be achieved. We discuss the diagnostic difficulties in the evaluation of pituitary disease in pregnancy.
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PMID:Hyponatremia associated coma due to pituitary apoplexy in early pregnancy: a case report. 1991 72