Addison’s disease in pregnancy: Case report, management, and review of the literature

Margulies, Samantha L.; Corrigan, K; Bathgate, Susanne L.; Macri, Charles J.

doi:10.3233/npm-190231

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…In the first and second trimester, the substitution of hydrocortisone can usually be maintained at the same level (15-30 mg daily, divided into two or three doses). After the 24 th week of gestation, the doses are often readjusted and increased by 20-40% due to physiological hypercortisolemia present in healthy pregnant women ( 45 ). Fludrocortisone, a synthetic mineralocorticoid, can be used the same way as in the general population – 0.05-0.2 mg daily, with close monitoring of blood pressure and serum electrolytes.…”

Section: Immune Adaptations In Pregnancy and The Special Role Of Prog...mentioning

confidence: 99%

Endocrine Autoimmunity in Pregnancy

Świątkowska−Stodulska

Berlińska

Stefańska

et al. 2022

Front. Immunol.

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Human gestation leads to a number of physiological alterations which peak at the development of placentta known for, among many other functions, being a transient but highly potent endocrine organ. Hormonal activity of placenta is marked by its ability to continuously produce and secrete high levels of progesterone. Progesterone guards the well-being of the fetoplacental unit throughout the gestation and one of the proposed mechanisms of this principle involves the development of local and systemic immune tolerance mainly due to impediment of CD4+ lymphocyte activation. However, though these alterations are present and well-established, autoimmunity is not entirely rare and a wide spectrum of diseases can continue, or develop de novo, throughout the gestation or even after the delivery. Up-to-date data supports the existence of a relationship between the clinical course of chosen autoimmune diseases and levels of circulating sex steroids.The most common autoimmune endocrinopathies in pregnant women are Hashimoto’s disease, Graves’ disease, and, more rarely, primary adrenal insufficiency in the form of Addison’s disease. Gestation can influence the clinical course of these endocrinopathies in patients who were diagnosed before conception. Multiple particles, like TSH-receptor stimulating antibodies, thyroid hormones, glucocorticoids, and anti-thyroid medications, can cross the placental barrier and evoke biological action in fetal tissues. Thyroid pathology in the form of postpartum thyroiditis is particularly prevalent in patients with positive anti-thyroperoxidase and anti-thyroglobulin antibodies. Certain populations are more at risk of developing numerous gestational complications and require regular follow-up. In our paper, we would like to address physiological, physiopathological, and clinical aspects of endocrine autoimmunity throughout human gestation, as well as special circumstances to consider in pregnant women.

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Section: Immune Adaptations In Pregnancy and The Special Role Of Prog...mentioning

confidence: 99%

Endocrine Autoimmunity in Pregnancy

Świątkowska−Stodulska

Berlińska

Stefańska

et al. 2022

Front. Immunol.

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“…Early diagnosis can be challenging as pregnancy can overlap with some of the symptoms of adrenal insufficiency, such as fatigue, nausea, vomiting, and abdominal discomfort. Hyperpigmentation is a more specific sign of primary adrenal insufficiency ( 110 ). In contrast to pregnancy-associated chloasma, hyperpigmentation in Addison’s disease typically involves areas of increased mechanical friction, including creases of hands, extensor surfaces, scars, nipples, and mucous membranes.…”

Section: Pregnancy In Adrenal Insufficiencymentioning

confidence: 99%

Fertility and pregnancy in adrenal insufficiency

Green,

Dineen,

O’Reilly

et al. 2023

Endocrine Connections

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Despite the availability of adrenal hormone replacement therapy, patients with adrenal insufficiency can be affected by reduced fertility and parity. Patients with well managed adrenal insufficiency are expected to have uneventful pregnancies and favourable outcomes, but an increased risk of maternal and neonatal complications have been reported in some cases. Many physiological changes occur to the hypothalamic-pituitary-adrenal (HPA) axis during pregnancy, often making a new diagnosis and management of adrenal insufficiency challenging. The management of adrenal insufficiency also needs to reflect the physiologic changes of pregnancy, often requiring increased doses of glucocorticoid as pregnancy progresses and in some circumstances mineralocorticoid replacement (in primary adrenal insufficiency patients only), especially in the third trimester. To date, there are no prospective data guiding management of adrenal insufficiency in pregnancy. In this review, we focus on the impact of adrenal insufficiency on fertility and parity based on the aetiology of adrenal insufficiency and provide a practical approach to the management of patients with adrenal insufficiency before and during pregnancy.

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Adrenal insufficiency in pregnancy: Physiology, diagnosis, management and areas for future research

Lee

Torpy

2022

Rev Endocr Metab Disord

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Addison’s disease in pregnancy: Case report, management, and review of the literature

Cited by 4 publications

References 14 publications

Endocrine Autoimmunity in Pregnancy

Endocrine Autoimmunity in Pregnancy

Fertility and pregnancy in adrenal insufficiency

Adrenal insufficiency in pregnancy: Physiology, diagnosis, management and areas for future research

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