Endocrinopathy in a Puerperal with Severe Community-Acquired Pneumonia, Requiring the Use of Veno Venous Extracorporeal Membrane Oxygenation (Сase Report)

Justification: The article presents a clinical case of adrenal and thyroid dysfunction and their correction in a puerperal with severe community-acquired pneumonia requiring extracorporeal membrane oxygenation (ECMO). We discuss the lack of diagnostic criteria for adrenal and thyroid dysfunction in critical condition; diagnosis and tactics of treatment with hydrocortisone and levothyroxine sodium in critical illness: initiation, duration, dose titration and withdrawal of the preparation. The aim. The frequency of extracorporeal membrane oxygenation in pregnant women and in the early postpartum period has increased over the last decade and a half. Endocrinopathy of critical illness often determines the severity of patients’ condition and their outcome. Objective: Timely detection of adrenal and thyroid dysfunction and their correction in a puerperal with severe community-acquired pneumonia requiring extracorporeal membrane oxygenation. Materials and methods: The puerperal with community-acquired bilateral polysegmental pneumonia of severe degree, viral-bacterial etiology (H1N1 and Acinetobacter baumannii) required the use of extracorporeal membrane oxygenation. Results: The development of сritical illness–related corticosteroid insufficiency was considered on the basis of noradrenaline requirement. On the background of the conducted combined therapy (noradrenaline and hydrocortisone) early hemodynamic stabilization was achieved. Thyroid dysfunction caused by critical condition was considered with decreased plasma levels of thyroid stimulating hormone and triiodothyronine development of intestinal dysfunction and sinus bradycardia. Conclusion: Development of adrenal dysfunction (vascular insufficiency that required the use of vasopressors, hyponatremia) and thyroid dysfunction (combination of three or more factors: bradycardia, gastrostasis, spontaneous hypothermia or absence of fever against the background of infectious process, thyroid stimulating hormone level at or below the lower limit of normal, low levels of thyroid hormone). Timely and adequate correction of endocrine dysfunction in the development of critical illness makes it possible to reduce the severity of the intensive care patient’s condition and improve the outcome.