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A 35 yr old primigravida known to have Hypogonadotropic hypogonadism and empty sella syndrome , conceived with IVF presented to the ER department at 12 week gestation with altered sensorium, aggressive behavior, irrelevant talk since last 6-8 hours with history of vomiting, fever and severe headache since the last 2 days. She was on progesterone support medication, thyroxine 25 mcg and folic acid. Serum electrolytes at admission showed sodium 99.4 M eq, chloride 67.2 M eq and was admitted to ICU for slow sodium correction however sodium levels rose unexpectedly quickly in spite of careful attempt at correction. Patient was seen by endocrinologist who suggested Cerebral salt wasting syndrome and steroid cover was commenced, she recovered and was discharged home only to be readmitted 4 days later with h/o confusion and irrelevant talking. An urgent brain MRI showed extrapontine myelinolysis and EEG done showed abnormalities with periodic sharp and slow waves from right temporal region, she was admitted in ICU under a neurologist. Psychiatry review diagnosed her with manic psychosis, secondary to organic cause and started on tablet Olanzapine 5mg for her altered & aggressive behavior. With supportive care she improved and was discharged on Tablet Syndopa which was withdrawn after 2 weeks , hydrocortisone sertraline, thyroxine in addition to her normal pregnancy supplement medication. She was seen at 4 weekly intervals throughout pregnancy , she developed severe pedal edema with no overt cause ,assumed to be due to steroid intake Routine antenatal checkups and subsequent serial fetal growth scans were normal. She chose to have an elective cesarean section at 38 weeks which was performed uneventfully with female baby of 2.7 kg born. Postnatally she had lactation failure due to low prolactin and baby was formula fed, postnatal recovery was otherwise uneventful.