HELLP syndrome in a pregnant woman with a salt-wasting form of congenital adrenal hyperplasia

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Abstract

Relevance: Fertility rate in women with classic congenital adrenal hyperplasia (CAH) is significantly reduced. HELLP syndrome is a severe complication of pregnancy characterized by the development of hemolysis, increased hepatic transaminases and thrombocytopenia. Currently, there are no uniform recommendations for the management of pregnant women with CAH, especially the patients with hypertensive syndromes.

Case report: The clinical observation of the HELLP syndrome development in the third trimester of pregnancy in a patient with a salt-wasting form of CAH is presented. The management of this patient was complicated by the discordance of clinical symptoms, namely, arterial hypertension in the HELLP syndrome and hyponatremia due to the CAH decompensation. Possible mechanisms of pregnancy complications in this patient were analyzed. Since there are no similar clinical cases in the literature, this clinical case should be considered as an example of the influence of somatic pathology on the development of pregnancy complications by obstetricians and gynecologists.

Conclusion: Pregnant women with CAH are at risk of complications and should be managed by an interdisciplinary team including an obstetrician-gynecologist, endocrinologist, therapist, anesthesiologist, and neonatologist.

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About the authors

Tatyana V. Kirsanova

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Author for correspondence.
Email: a_tatya@mail.ru
ORCID iD: 0000-0002-1470-4311

PhD, Leading Researcher at the Institute of Anesthesiology-Resuscitation and Transfusiology

Russian Federation, Moscow

Anna I. Sazonova

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: anyta_sazonova@mail.ru
ORCID iD: 0000-0002-1776-0124

PhD, Endocrinologist at the Internal Medicine Department

Russian Federation, Moscow

Natalya I. Klimenchenko

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: n_klimenchenko@oparina4.ru
ORCID iD: 0000-0002-9901-225X

PhD, Senior Researcher at the 1st Obstetric Department

Russian Federation, Moscow

Roza M. Esayan

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: r_esayan@oparina4.ru
ORCID iD: 0000-0002-6808-113X

PhD, Head of the Internal Medicine Department

Russian Federation, Moscow

Yurii A. Gerasimov

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: y_gerasimov@oparina4.ru
ORCID iD: 0009-0002-8988-2777

Anesthesiologist at the ICU Department

Russian Federation, Moscow

Ekaterina E. Sakhnova

O.M. Filatov City Clinical Hospital No. 15, Moscow Department of Health

Email: sakhnova.ee@gmail.com
ORCID iD: 0000-0002-7102-5323

Endocrinologist

Russian Federation, Moscow

References

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