Adrenal disorders in pregnancy, labour and postpartum - an overview.

Adrenal disorders may manifest during pregnancy for the first time, or present from before pregnancy as either undiagnosed or diagnosed and treated. They may present as hormonal hypofunction or hyperfunction, or with mass effects or other non-endocrine effects. Adrenal disorders such as Cushing's syndrome, Addison's disease, pheochromocytoma, primary hyper-aldosteronism and adreno-cortical carcinoma are rare in pregnancy. Pregnancy presents special problems in the evaluation of the hypothalamic-pituitary-adrenal and renin-angiotensin-aldosterone axis as these undergoe major changes during pregnancy. Diagnosis is challenging as symptoms associated with pregnancy are also seen in adrenal diseases. A timely diagnosis and treatment is critical as these disorders can cause maternal and foetal morbidity and mortality. A high index of suspicion must be maintained as they can go unrecognised and untreated. An early diagnosis and treatment often improves outcomes. The aim of this article is to review the patho-physiology, clinical manifestation, diagnosis and management of various adrenal disorders during pregnancy.

Controversies related to vitamin D deficiency effect on the maternal and feto-placental unit - an update.

Vitamin D deficiency (Vit D deficiency) is a global health concern and a common occurrence especially among pregnant women. It has been suggested that Vit D deficiency has implications on both the mother and the foetus. Vitamin D deficiency is the most under-diagnosed nutritional deficiency in the world, affecting the majority of individuals, irrespective of their geography, gender, age or race. Vitamin D deficiency is also linked with several diseases (autoimmune diseases, cancer, cardiovascular, dementia and musculoskeletal diseases). Therefore, appropriate supplementation is required in a deficient population. A diagnosis can be missed as symptoms associated with pregnancy are also seen in vitamin D-deficient women. A timely diagnosis and treatment can be beneficial as these disorders can cause maternal and foetal morbidity. Vitamin D status during pregnancy has been associated with maternal and foetal morbidity, but reported findings are inconsistent.

Cervical lymphadenopathy - an unusual presentation of carcinoma of the cervix: a case report.

INTRODUCTION: The clinical presentation of carcinoma of the cervix as cervical lymphadenopathy has not been described before. We report a case of this unusual manifestation of cervical cancer. CASE PRESENTATION: A 51-year-old woman presented to our Head and Neck department with cervical lymphadenopathy. A positron emission tomography scan revealed the primary tumour to be in the cervix and a cervical biopsy confirmed carcinoma of the cervix. CONCLUSION: Recurrences of carcinoma of the cervix presenting as lymphadenopathy have been described before but this is the first time a clinical presentation of carcinoma of the cervix as cervical lymphadenopathy has been described. Although metastasis from the cervix to the cervical lymph nodes is rare, this can be explained by outlining the drainage of the lymphatic system from the cervix.

Mucocele of the appendix - a diagnostic dilemma: a case report.

INTRODUCTION: Mucocele of the appendix secondary to mucinous cystadenoma is a rare clinical finding. Clinical presentation is varied with more than half being asymptomatic. CASE PRESENTATION: We report such a case presenting to the surgeons where initial clinical findings and investigations suggested an ovarian cyst. The patient was subsequently referred to the Gynaecologists for further management. In spite of extensive preoperative investigations, the diagnosis was only made at the time of surgery. CONCLUSION: In women presenting with a right iliac fossa mass and clinical features not indicative of gynaecological pathology, an appendiceal origin should be considered in the differential diagnosis.