HELLP syndrome in a pregnant woman with a salt-wasting form of congenital adrenal hyperplasia
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.Kirsanova T.V., Sazonova A.I., Klimenchenko N.I., Esayan R.M., Gerasimov Yu.A., Sakhnova E.E.
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.
Authors’ contributions: Kirsanova T.V. – developing the concept and design of the study, general supervision; Sazonova A.I. – collecting and processing the material; Kirsanova T.V., Sazonova A.I., Gerasimov Yu.A., Sakhnova E.E. – writing the text; Klimenchenko N.I., Esayan R.M. – editing the article.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The article was prepared without sponsorship.
Patients’ Consent for Publication: The patient provided an informed consent for the publication of her data.
For citation: Kirsanova T.V., Sazonova A.I., Klimenchenko N.I., Esayan R.M.,
Gerasimov Yu.A., Sakhnova E.E. HELLP syndrome in a pregnant woman with
a salt-wasting form of congenital adrenal hyperplasia.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (3): 149-154 (in Russian)
https://dx.doi.org/10.18565/aig.2022.314
Keywords
HELLP syndrome
preeclampsia
CAH
21-hydroxylase
pregnancy
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Received 26.12.2022
Accepted 24.03.2023
About the Authors
Tatyana V. Kirsanova, PhD, Leading Researcher at the Institute of Anesthesiology-Resuscitation and Transfusiology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, +7(926)248-45-60, a_tatya@mail.ru, https://orcid.org/0000-0002-1470-4311,117997, Russia, Moscow, Academician Oparin str., 4.
Anna I. Sazonova, PhD, endocrinologist at the Internal Medicine Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, +7(909)961-08-91, anyta_sazonova@mail.ru, https://orcid.org/0000-0002-1776-0124,
117997, Russia, Moscow, Academician Oparin str., 4.
Natalya I. Klimenchenko, PhD, Senior Researcher at the 1st Obstetric Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, +7(903)756-45-72, n_klimenchenko@oparina4.ru, https://orcid.org/0000-0002-9901-225X,
117997, Russia, Moscow, Academician Oparin str., 4.
Yurii A. Gerasimov, anesthesiologist at the ICU Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, +7(926)123-05-93, y_gerasimov@oparina4.ru, https://orcid.org/ 0009-0002-8988-2777, 117997, Russia, Moscow, Academician Oparin str., 4.
Roza M. Esayan, PhD, Head of the Internal Medicine Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, +7(926)395-81-06, r_esayan@oparina4.ru, https://orcid.org/0000-0002-6808-113Х, 117997, Russia, Moscow, Academician Oparin str., 4.
Ekaterina E. Sakhnova, endocrinologist, O.M. Filatov City Clinical Hospital No. 15, Moscow Department of Health, sakhnova.ee@gmail.com,
https://orcid.org/0000-0002-7102-5323, 111539, Russia, Moscow, Veshnyakovskaya str., 23.
Corresponding author: Tatyana V. Kirsanova, a_tatya@mail.ru
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