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Pratik R Jaiswal1, Pallavi Bhakaney1, Vaishnavi Yadav1
1Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences (DMIMS), Wardha, IND.
Insights
Congenital adrenal hyperplasia (CAH) in infants can lead to adrenal crisis, complicated by infections like bronchopneumonia and leptomeningitis. This case highlights the importance of multidisciplinary respiratory therapy and parent education for managing these critical conditions.
Area of Science:
- Pediatrics
- Endocrinology
- Infectious Diseases
Background:
- Congenital adrenal hyperplasia (CAH) is a group of hereditary disorders affecting adrenal hormone production.
- CAH requires early diagnosis and management due to potential life-threatening adrenal crises.
- Adrenal crisis can be precipitated by infections, necessitating prompt medical intervention.
Observation:
- An 11-month-old infant with known CAH presented with poor feeding, fever, and seizures, indicating a possible adrenal crisis.
- The infant was diagnosed with bronchopneumonia and leptomeningitis, complicating the adrenal crisis.
- Respiratory distress was a significant concern, requiring intubation and mechanical ventilation.
Findings:
- The case demonstrates the critical interplay between CAH, adrenal crisis, and severe infections.
- Respiratory therapy, including airway clearance techniques and bronchodilators, was crucial for managing respiratory compromise.
- Parent education on managing CAH and recognizing crisis symptoms is vital for home care.
Implications:
- A holistic, multidisciplinary approach is essential for optimizing outcomes in infants with CAH and adrenal crisis.
- Early recognition and aggressive management of infections are paramount in preventing fatal complications.
- This case underscores the need for specialized respiratory support and comprehensive care strategies for affected infants.
Abstract:
A set of hereditary diseases affecting the adrenal glands, a couple of walnut-sized structures above the kidneys, is known as congenital adrenal hyperplasia (CAH). The adrenal glands generate essential hormones like cortisol, mineralocorticoids, and androgens. It is usually diagnosed in the early neonatal period. The documentation of this case study is aimed to provide a case of an infant with CAH associated with bronchopneumonia and leptomeningitis. Brought with complaints of poor feeding, moderate fever associated with chills, and loose stools, was an 11-months-old patient with a known diagnosis of CAH. Symptoms have shown that the baby was in a possible adrenal crisis. He was intubated with an endotracheal tube after repeated episodes of seizures. Investigations revealed signs of bronchopneumonia and leptomeningitis. A thorough assessment, once completed, helped in analyzing relevant problems to be treated with respiratory therapy. Respiratory therapy, in this case, was aimed at improving the blood oxygen levels and assisting breathing by clearing out secretions and opening up the airways. Parent education was the foremost part of the treatment regime, followed by bronchodilator administration, conventional chest physiotherapy, postural drainage positions in the mother's lap, lung squeezing technique, and perioral pressure. A holistic and multidisciplinary approach is beneficial in patients with CAH undergoing an adrenal crisis. It needs to be offered to the patients who would be benefited, considering the effect, which needs to be reassessed on specific outcomes with changes in the management with the improving condition.
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