Adrenal Disorders in Pregnancy

Abdelmannan, Dima; Aron, David C.

doi:10.1016/j.ecl.2011.09.001

Cited by 32 publications

(21 citation statements)

References 65 publications

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“…During pregnancy, the incidence of adrenal disorders (particularly adenomas) and CD is 60 and 33% respectively, in contrast to non-pregnant patients, where the incidence is 15% for adrenal adenoma and 70% for CD (1). This preponderance is probably related to the exclusive cortisol production from adrenal adenomas as compared to CD, which exhibits a mixed secretion of cortisol and androgens (15). Lindsay et al (1), upon reviewing 136 pregnancies in 122 women with CS, described the following etiologies: CD (nZ40); adrenal adenoma (nZ56); adrenal carcinoma (nZ12); ectopic ACTH secretion (EAS) (nZ4); Carney's complex (nZ1); and ACTH-independent hyperplasia (nZ4), possibly resulting from aberrant receptor stimulation.…”

Section: Pregnancy With Csmentioning

confidence: 85%

MANAGEMENT OF ENDOCRINE DISEASE: Management of pregnant patients with Cushing's syndrome

Bronstein¹,

Machado²,

Fragoso³

2015

European Journal of Endocrinology

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Progress in the diagnosis and treatment of endocrine diseases has turned pregnancy into a possibility for women with such medical disorders, including Cushing's syndrome (CS). Nevertheless, despite its rarity, pregnancy in patients with CS can be troublesome because of the risk of maternal-fetal complications. Therefore, hypercortisolism, if present, should be surgically or medically controlled in most cases. Moreover, changes in the hypothalamic-pituitary-adrenal axis during normal pregnancy may mislead the diagnosis of CS during this period, because many laboratory assessments suggestive of CS may be present in normal pregnancy, with clinical features mimicking those seen in patients with CS. The aim of the present review is to update the diagnostic approach to this medical condition, mainly for pregnant women without previous diagnosis of CS, and to describe the therapeutic strategies for CS during pregnancy in order to minimize complications for both mother and fetus.

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Section: Pregnancy With Csmentioning

confidence: 85%

MANAGEMENT OF ENDOCRINE DISEASE: Management of pregnant patients with Cushing's syndrome

Bronstein¹,

Machado²,

Fragoso³

2015

European Journal of Endocrinology

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“…24 Box 1 HPA axis changes in a normal pregnancy Increase in zona fasciculata in adrenal gland 1,2 Increase in total and free cortisol and UFC Starting about 11 weeks' gestation Free cortisol levels by 1.2-fold, 1.4-fold, and 1.6-fold and 24-hour UFC by 1.7-fold, 2.4-fold, and 3.1-fold in the first, second, and third trimesters respectively 13 Increase in ACTH Beginning in the late first trimester, peaking during labor and delivery 16,17 Increase in CRH Mostly from placental production Detectable then steadily increases in middle of the second trimester, with a sharp increase at the end of gestation 13,15 Increase in CBG 13 Increase in aldosterone Levels increase steadily up to 3-fold to 8-fold then plateau in the third trimester [21][22][23] Increase in plasma renin activity Approximately 4-fold by eighth week; 7-fold at term 23 Increase in deoxycorticosterone. 24,26,27 CRH and ACTH levels return to nonpregnant values within 24 hours of delivery, 18 and, at 2 to 3 months postpartum, plasma free cortisol and UFC levels return to baseline but CBG and total plasma cortisol levels remain increased. 13 …”

Section: Changes To the Hypothalamus-pituitary-adrenal Axis In Pregnancymentioning

confidence: 97%

“…The increase in prostaglandin synthesis and arterial venous shunt of the placental unit cause a decrease in systemic vascular resistance which are thought to initiate an activation of RAAS. 23 Extrarenal production of renin by the ovaries and maternal decidua as well as stimulation of renal renin release directly by estrogen 24,25 likely contribute to the early increase in renin. The direct effect of estrogen and the estrogen-stimulated increase in CBG from the liver contribute to the increase in PRA, promoting increased angiotensin II levels and ultimately, increased aldosterone production from the adrenal glands.…”

Section: Changes To the Hypothalamus-pituitary-adrenal Axis In Pregnancymentioning

confidence: 98%

Management of Adrenal Tumors in Pregnancy

Eschler¹,

Kogekar²,

Pessah-Pollack³

2015

Endocrinology and Metabolism Clinics of North America

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“…MIBG is not considered to be safe for the fetus because of placental transfer of the isotope resulting in radiation and iodine exposure (17,18).…”

Section: Diagnosismentioning

confidence: 99%

ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature

Weerd

Noord

Loeve³

et al. 2017

European Journal of Endocrinology

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Pheochromocytoma in pregnancy is extremely rare. Early recognition is crucial as antepartum diagnosis can largely decrease maternal and fetal mortality rates. As symptoms of pheochromocytoma are rather similar to those of other far more common causes of hypertension during pregnancy, timely diagnosis is a challenge. In pregnant patients, similar to non-pregnant patients, increased plasma and/or 24-h urine (nor)metanephrine concentrations most reliably confirm the diagnosis of pheochromocytoma. MRI and ultrasound are the only imaging modalities that can be used safely during pregnancy to localize the tumor. During pregnancy, pretreatment consists of alpha blockade as usual. However, dosing of α-adrenergic receptor blockers during pregnancy is a challenge as hypertension must be treated while preserving adequate uteroplacental circulation. When the diagnosis is made within the first 24 weeks of pregnancy, it is generally recommended to remove the tumor in the second trimester, while resection is generally postponed till after delivery when the diagnosis is made in the third trimester and medical pretreatment is sufficient. Both during and after pregnancy, laparoscopic surgery is the preferred approach for resection of the tumor. There is no consensus in literature about the preferred route and timing of delivery. Therefore, in our opinion, decisions should be made on an individual basis by an experienced and dedicated multidisciplinary team. Over the last decades, maternal and fetal prognosis has improved considerably. Further increasing awareness of this rare diagnosis and treatment of these patients by a dedicated team in a tertiary referral hospital are critical factors for optimal maternal and fetal outcome.

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Adrenal Disorders in Pregnancy

Cited by 32 publications

References 65 publications

MANAGEMENT OF ENDOCRINE DISEASE: Management of pregnant patients with Cushing's syndrome

MANAGEMENT OF ENDOCRINE DISEASE: Management of pregnant patients with Cushing's syndrome

Management of Adrenal Tumors in Pregnancy

ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature

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