Hydrocortisone improves somnolence without hypotension in the postpartum period

Hypothalamic-pituitary-adrenal (HPA) axis abnormality and adrenal insufficiency secondary to chronic steroid treatment can be present in the perioperative period. When this occurs in pregnant patients during the peripartum period, the usually expected physiological changes may not be present. The hypotension associated with adrenal insufficiency may be masked by the normal physiological changes of pregnancy and delivery. We report on a patient whose only presenting symptom was mental status changes; this occurred without any significant hemodynamic changes. These mental status changes responded within minutes to a single dose of hydrocortisone. We recommend administering a pharmacological dose of steroid as a maneuver to rule out adrenal insufficiency when faced with a patient with an unexplained altered mental status while other differential diagnoses are considered.