An Autopsy of Acute Adrenal Insufficiency Resulting from Infarction of Both Adrenal Glands, in a Pregnant Woman with Metastatic Carcinoma of the Breast

Abstract

Acute Adrenal Insufficiency (AAI) is a life-threatening medical emergency, associated with high mortality, and requires early diagnosis and prompt management. This is an unusual case report of a 34-year-old female who was diagnosed with breast cancer, in the second trimester of pregnancy. She presented at 33 weeks gestation, in the emergency services, with convulsions, weakness, altered sensorium and high-grade infiltrating duct carcinoma of breast with liver metastasis. She had also received a single cycle of chemotherapy with adriamycin and cyclophosphamide, at 33 weeks of pregnancy. Her condition deteriorated within 12-16 hours, and she developed abdominal pain, generalised weakness and convulsions. The patient was induced into labour, which was complicated, and delivered a still born male child. She also developed acute kidney injury and severe electrolyte imbalance, and died within four days of admission. A complete postmortem examination was performed where the cause of death was AAI following infarction of both adrenal glands in a background of metastatic carcinoma of the breast. It is strongly suspected that chemotherapy with adriamycin and cyclophosphamide is the primary cause of AAI in the present case. However, the etiology could also be multifactorial as factors like, sepsis, intrauterine foetal death and Disseminated Intravascular Coagulation (DIC) were also present.