MANAGEMENT OF ENDOCRINE DISEASE: Fertility, pregnancy and lactation in women with adrenal insufficiency

Anand, Gurpreet; Beuschlein, Felix

doi:10.1530/eje-17-0975

Cited by 26 publications

(34 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…22 In the literature, the underlying causes for AI during pregnancy are almost equally distributed between primary (44%) and secondary (45%) causes. 23 Among the latter, prolonged exogenous GC treatment for pre-existing various conditions (such as asthma, rheumatoid arthritis and inflammatory bowel disease or posttransplant) is the most common cause. Aside of oral, high dose inhaled and parenteral formulations, topical cream (e.g.…”

Section: Breastfeeding and Steroidsmentioning

confidence: 99%

Glucocorticoids in pregnancy

Pofi

Tomlinson

2019

Obstet Med

View full text Add to dashboard Cite

The physiological changes that occur during pregnancy include altered regulation of the hypothalamo-pituitary-adrenal axis. The fetoplacental unit plays a major role in this, together with alteration of circulating cortisol-binding globulin levels, with a net effect to increase both total and free cortisol levels. Importantly, there are several pathological conditions that require steroid treatment or replacement during pregnancy, and optimizing therapy is clearly crucial. The potential for acute and chronic adverse effects that can impact upon both the mother and the fetus makes the decision of how and when to instigate steroid therapy particularly challenging. In this review, we describe the physio-pathological changes to the hypothalamo-pituitary-adrenal axis that occur during pregnancy, tools to assess endogenous glucocorticoid reserve as well as discuss treatment strategies and the potential for the development of adverse events.

show abstract

Section: Breastfeeding and Steroidsmentioning

confidence: 99%

Glucocorticoids in pregnancy

Pofi

Tomlinson

2019

Obstet Med

View full text Add to dashboard Cite

show abstract

“…Despite controversies regarding follow-up intervals and dose adjustments, levothyroxine, corticoids, and DDAVP are regarded as safe for the fetus during pregnancy [9,11,12,20,[22][23]. The obstetrician team opted for a caesarean section in the present case.…”

mentioning

confidence: 93%

“…Based on that, it has been suggested that hydrocortisone doses are increased up to 20-40% in the last trimester [11]. Due to the lack of sufficient evidence, patients should be followed-up once every trimester with dosage adaptation based on the individual course of pregnancy [12].…”

mentioning

confidence: 99%

Pregnancy, Diabetes Insipidus and Adrenal Insufficiency after Surgical Treatment in Clinically Non-functioning Pituitary Adenoma: A Case Report

Ben¹,

Naliato²,

Violante³

2018

Crit Care Obst & Gyne

View full text Add to dashboard Cite

We report a case of successful pregnancy despite the development of central Diabetes Insipidus (DI) and adrenal insufficiency after surgical treatment of a clinically NonFunctioning Pituitary Adenoma (NFPA).A 36-year-old female who underwent pituitary surgery to treat a clinically NFPA, presented features of central DI and adrenal insufficiency both treated and compensated, and successfully became pregnant.The presence of both conditions in women who previously underwent pituitary surgery to treat NFPA and who became pregnant without intercurrences for either mother and the fetus is unusual. Additionally, in the present case, there was no need for adjustments in the pharmacological therapy.The advent of central DI or adrenal insufficiency after transsphenoidal surgery are frequent complications reported as independent isolated phenomena during the immediate postoperative period or in the context of hypopituitarism. However, the presence of both conditions in women who previously underwent pituitary surgery to treat clinically NFPA and who became pregnant without intercurrences for either mother and the fetus is unusual, which prompted this case report.

show abstract

“…The precise prevalence of AD in pregnancy is not known. Women with AD show reduced parity ( 2 , 3 ), the cause of that being probably multifactorial – women with chronic diseases can be reluctant to become pregnant for concerns about associated complications, and other concomitant autoimmune diseases as type 1 diabetes and autoimmune thyroid disease can cause reduced fertility ( 4 ). The loss of adrenal androgens could play a role in the fertility of these patients, although this is not clear ( 2 ), and may affect libido and sexual activity ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…Gestation in these patients requires specific and attentive care. An acute adrenal crisis, with severe risk for mother and child, can be elicited by hyperemesis gravidarum, infections and delivery (both vaginal and cesarean) ( 4 ) or failure to adequately adjust substitution therapy doses, which can be due to poor adherence, lack of education or insufficient medical monitoring.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Addison’s disease during pregnancy

Oliveira

Lages

Paiva

et al. 2018

Endocrinology, Diabetes &Amp; Metabolism Case Reports

View full text Add to dashboard Cite

SummaryAddison’s disease, or primary adrenocortical insufficiency, is a long-term, potentially severe, rare endocrine disorder. In pregnancy, it is even rarer. We report the case of a 30-year-old pregnant patient with Addison’s disease, referred to Obstetrics-Endocrinology specialty consult at 14 weeks gestation. She had been to the emergency department of her local hospital various times during the first trimester presenting with a clinical scenario suggestive of glucocorticoid under-replacement (nausea, persistent vomiting and hypotension), but this was interpreted as normal pregnancy symptoms. Hydrocortisone dose was adjusted, and the patient maintained regular follow-up. No complications were reported for the remainder of gestation and delivery. Pregnant patients with Addison’s disease should be monitored during gestation and in the peripartum period by multidisciplinary teams. Adjustments in glucocorticoid and mineralocorticoid replacement therapy are often necessary, and monitoring should be based mainly on clinical findings, which becomes increasingly difficult during pregnancy. Patient education and specialized monitoring are key to avoiding complications from under- or over-replacement therapy in this period.Learning points:An increase in glucocorticoid replacement dose is expected to be necessary during pregnancy in a woman with Addison’s disease.Patient education regarding steroid cover and symptoms of acute adrenal crisis are fundamental.Monitoring in this period is challenging and remains mainly clinical.The increase in hydrocortisone dose often obviates the need to increase fludrocortisone dose.

show abstract

MANAGEMENT OF ENDOCRINE DISEASE: Fertility, pregnancy and lactation in women with adrenal insufficiency

Cited by 26 publications

References 43 publications

Glucocorticoids in pregnancy

Glucocorticoids in pregnancy

Pregnancy, Diabetes Insipidus and Adrenal Insufficiency after Surgical Treatment in Clinically Non-functioning Pituitary Adenoma: A Case Report

Treatment of Addison’s disease during pregnancy

Contact Info

Product

Resources

About