Adrenal Tumor Diagnosis for Pregnant Woman Consuming Five Liters of Water Daily Highlights Risks of Hyperaldosteronism and Preeclampsia

A complex medical case involving a 38-year-old pregnant woman in Vietnam has drawn international attention to the critical intersection of endocrine health and high-risk maternity care. The patient, identified as "H," presented with a highly unusual symptom: an insatiable thirst that led her to consume approximately five liters of water every day. While hydration is a fundamental component of a healthy pregnancy, this level of consumption, coupled with a complex obstetric history, prompted medical professionals at FV Thomson Maternity to launch an intensive investigation. The subsequent discovery of an adrenal tumor underlying her symptoms serves as a poignant reminder of how secondary medical conditions can complicate maternal outcomes and necessitate a multidisciplinary approach to healthcare.

The patient entered her fourth pregnancy with a documented history of significant medical challenges, including previous deliveries of large-for-gestational-age infants, chronic hypertension, and a pattern of increasingly premature births. Furthermore, her previous pregnancies had been marked by persistently low potassium levels, a condition known as hypokalemia. These factors, combined with her age and a high body mass index (BMI), immediately classified her as a high-risk patient. Dr. Vo Thi Thanh Van, MD, MSc, a leading specialist at FV Hospital, noted that the combination of multiple previous cesarean section scars and maternal obesity significantly elevated the risk of eclampsia—a life-threatening condition characterized by high blood pressure resulting in seizures.

Clinical Presentation and the Investigation of Polydipsia

The most striking clinical feature of H’s fourth pregnancy was her extreme polydipsia, or excessive thirst. During her hospitalization for observation, the obstetric team noted that she was not only drinking five liters of water daily but was also excreting approximately six liters of urine. This discrepancy suggested a significant electrolyte imbalance or a failure in the body’s water-regulation mechanisms. Initially, the medical team suspected diabetes insipidus, a rare disorder that occurs when the kidneys are unable to conserve water, often due to a deficiency of the antidiuretic hormone (ADH) or a lack of response to it.

To test this hypothesis, doctors implemented a controlled water restriction protocol to observe how her kidneys responded to decreased intake. Surprisingly, the patient’s urine remained concentrated even when her water intake was limited, which effectively ruled out diabetes insipidus. This finding led the diagnostic team to pivot toward more complex endocrine possibilities. They began to investigate two concurrent conditions: hypokalemia triggered by primary hyperaldosteronism—potentially caused by an adrenal tumor—and a psychological component known as psychogenic polydipsia, where the urge to drink water becomes compulsive.

Hyperaldosteronism occurs when the adrenal glands produce too much of the hormone aldosterone. This hormone plays a pivotal role in the body’s regulation of blood pressure by managing the balance of sodium and potassium in the blood. When aldosterone levels are pathologically high, the body retains too much sodium and loses too much potassium. The resulting potassium deficiency can lead to a host of symptoms, including extreme fatigue, muscle weakness, and, in severe cases, cardiac arrhythmias. For a pregnant woman, these risks are magnified, as the physiological stress of pregnancy already places a heavy burden on the cardiovascular system.

A Precarious Timeline: Managing Pregnancy with Undiagnosed Endocrine Issues

The management of H’s pregnancy required a delicate balancing act between stabilizing her blood pressure and addressing her chronic potassium deficiency without the aid of certain diagnostic tools that are contraindicated during pregnancy. Specifically, the medical team could not perform an MRI of the adrenal glands due to the potential risks to the developing fetus. Consequently, the diagnosis of an adrenal tumor remained a strong suspicion rather than a confirmed fact for much of the third trimester.

At 28 weeks of gestation, the patient’s condition reached a critical juncture. Her blood pressure spiked significantly, necessitating immediate hospitalization for continuous monitoring. While the medical team was able to stabilize her temporarily, the reprieve was short-lived. Two weeks after being discharged, at 30 weeks of gestation, she developed preeclampsia—a condition marked by high blood pressure and signs of damage to organ systems, most often the liver and kidneys. Preeclampsia is a leading cause of maternal and infant morbidity and mortality worldwide, and in H’s case, it was likely exacerbated by her underlying endocrine dysfunction.

During this period, the medical strategy shifted to harm reduction and fetal maturation. Dr. Van and her team prescribed oral potassium supplements and dietary adjustments, including the increased consumption of potassium-rich foods like bananas and coconut water. However, the patient was also strictly advised to limit her water intake to no more than 2.5 liters per day. This restriction was vital to prevent water intoxication, which can lead to hyponatremia (dangerously low sodium levels), increased renal strain, and further elevation of blood pressure. Dr. Van warned that if her potassium levels were to plummet further, the patient faced risks of muscle paralysis or even a fatal heart attack.

Surgical Intervention and Postpartum Confirmation

The primary goal of the medical team was to prolong the pregnancy long enough for the fetus to reach a viable stage of development. At 34 weeks, a point where the fetus’s lungs and other vital organs are generally sufficiently developed, the team proceeded with a planned cesarean section. Despite the high-risk nature of the surgery, the procedure was successful. H gave birth to a healthy baby girl weighing 2.6 kilograms. The successful delivery was a testament to the rigorous monitoring and personalized care plan developed by the FV Hospital staff.

With the pregnancy concluded, the medical team could finally utilize advanced imaging to confirm the source of the patient’s chronic health issues. A postpartum MRI of the adrenal glands revealed the presence of a tumor on the right adrenal gland. This tumor was identified as the primary driver of her hyperaldosteronism, explaining the years of low potassium and the extreme thirst experienced during her pregnancies. Following her recovery from the cesarean section, H was scheduled for adrenal surgery to remove the tumor, a procedure expected to resolve her hypertension and electrolyte imbalances permanently.

Analysis of Medical Implications and Multidisciplinary Care

This case highlights several critical aspects of modern obstetric medicine. First, it underscores the importance of investigating "unique" or "unusual" symptoms during pregnancy rather than dismissing them as mere side effects of the gestational state. While increased thirst is common in pregnancy, the extreme levels seen in this patient were a clear red flag for systemic pathology.

The successful outcome in this case was heavily dependent on the collaboration between three distinct medical departments:

1. Obstetrics: To manage the risks of preeclampsia, previous surgical scarring, and the timing of the delivery.
2. Pediatrics/Neonatology: To ensure the health of a baby born at 34 weeks, who required specialized care to transition to life outside the womb.
3. Endocrinology: To manage the complex hormonal imbalances caused by the adrenal tumor and to plan for definitive surgical treatment post-delivery.

Data from the World Health Organization (WHO) indicates that hypertensive disorders like preeclampsia complicate up to 10% of pregnancies worldwide. However, cases where hypertension is secondary to an adrenal tumor (such as a Conn’s syndrome or a pheochromocytoma) are exceedingly rare, occurring in less than 0.1% of pregnancies. Because these cases are so rare, they are often misdiagnosed as essential gestational hypertension, which can lead to improper treatment and dangerous outcomes.

Broader Impact on Maternal Health Screening

The story of Bunda H serves as a significant case study for the medical community in Southeast Asia and beyond. It raises questions about the necessity of more comprehensive endocrine screening for women who present with "atypical" high-risk factors, such as persistent hypokalemia or resistant hypertension during pregnancy.

Furthermore, the case illustrates the psychological toll of chronic, undiagnosed illness. The patient had visited multiple medical facilities over the years without receiving a definitive diagnosis for her low potassium. The resolution of her case not only provides a path to physical recovery but also highlights the role of specialized maternity hospitals in providing the high-level diagnostic expertise required for rare conditions.

As H prepares for her upcoming adrenal surgery, her case remains a vital reference point for healthcare providers. It demonstrates that even in the face of multiple high-risk factors—advanced maternal age, high BMI, multiple previous surgeries, and a hidden tumor—positive outcomes are possible through vigilant monitoring, patient education, and a commitment to investigating the root causes of clinical symptoms. The integration of specialized endocrine care into the obstetric framework is not just a luxury for complex cases; for patients like H, it is a life-saving necessity.