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September 19, 1977

Neonatal Subclinical Adrenal Insufficiency: Result of Maternal Steroid Therapy

JAMA. 1977;238(12):1279-1280. doi:10.1001/jama.1977.03280130061020

STEROID-INDUCED diabetes and greatly reduced urinary estriol levels developed in a pregnant woman with pseudotumor cerebri. The infant was born with subclinical adrenal insufficiency.

Report of a Case  A 19-year-old woman was examined at 10 weeks of gestation, with headaches, vomiting, and photophobia. Physical examination showed a 77 kg, 1.70 m normotensive woman. Eye findings included papilledema, slightly constricted visual fields, and enlarged blind spots bilaterally. A lumbar puncture showed an opening pressure greater than 590 mm of water. Skull roentgenogram, electroencephalogram, and echoencephalogram results were normal. Corticoid levels, measured by a modified fluorometric determination, were 25 μg/dl at 8:00 AM and 12 μg/dl at 4:00 PM. Diagnosis of benign intracranial hypertension was made and glycerol therapy was started. Symptoms abated, only to reappear a week later.After the results of her glucose tolerance test (GTT) were found to be normal, she was treated with dexamethasone, 4 mg every 6