Pregnancy complicated by autoimmune polyglandular syndrome type II: A case report

Gaither, Kecia; Wright, Ray; Apuzzio, Joseph J.; Gittens, Lisa; Ganesh, Vijaya

doi:10.1002/(sici)1520-6661(199805/06)7:3<154::aid-mfm10>3.3.co;2-l

Cited by 3 publications

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“…Due to the lack of data in pregnancy on the plasma cortisol response to SCT, existing thresholds for the plasma cortisol response may be no more useful than basal cortisol levels used alone. In several series basal cortisol levels were undetectable prior to an abnormal plasma cortisol following ACTH stimulation in confirmed AI during pregnancy (233,270).…”

Section: Random Cortisolmentioning

confidence: 96%

“…The mean age at presentation was 30 years and although tuberculosis was relatively uncommon (12%) that condition was more prevalent in males who had a mean age of presentation of 53 years(227). The association of AI with type 1 diabetes mellitus has been well described in the general population and in pregnancy(228)(229)(230)(231).At least seven pregnancies in association with autoimmune polyglandular syndrome (APS) type 2 or Schmidt's syndrome (primary autoimmune hypoadrenalism, type 1 DM, thyroid autoimmune disease), have been reported since the syndrome was originally described in 1926(225,(232)(233)(234)(235)(236)(237). This condition is more common in women and is more common than the other forms of APS.…”

mentioning

confidence: 99%

“…A high index of clinical suspicion should be present for the diagnosis in offspring of individuals with APS(232,233,238).The prevalence of APS 2 is probably over-represented in the literature of AI in pregnancy, as it is a unique multi-system endocrine disease. Three cases with APS presented as a new diagnosis of AI during pregnancy(233,234,236). An awareness of the association of type 1 diabetes or thyroid disease with AI is necessary to ensure adequate screening and recognition of APS prior to or during pregnancy.…”

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confidence: 99%

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The Hypothalamic-Pituitary-Adrenal Axis in Pregnancy: Challenges in Disease Detection and Treatment

2005

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Pregnancy dramatically affects the hypothalamic-pituitary-adrenal axis leading to increased circulating cortisol and ACTH levels during gestation, reaching values in the range seen in Cushing's syndrome (CS). The cause(s) of increased ACTH may include placental synthesis and release of biologically active CRH and ACTH, pituitary desensitization to cortisol feedback, or enhanced pituitary responses to corticotropin-releasing factors. In this context, challenges in diagnosis and management of disorders of the hypothalamic-pituitary-adrenal axis in pregnancy are discussed. CS in pregnancy is uncommon and is associated with fetal morbidity and mortality. The diagnosis may be missed because of overlapping clinical and biochemical features in pregnancy. The proportion of patients with primary adrenal causes of CS is increased in pregnancy. CRH stimulation testing and inferior petrosal sinus sampling can identify patients with Cushing's disease. Surgery is a safe option for treatment in the second trimester; otherwise medical therapy may be used. Women with known adrenal insufficiency that is appropriately treated can expect to have uneventful pregnancies. Whereas a fetal/placental source of cortisol may mitigate crisis during gestation, unrecognized adrenal insufficiency may lead to maternal or fetal demise either during gestation or in the puerperium. Appropriate treatment and management of labor are reviewed.

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Section: Random Cortisolmentioning

confidence: 96%

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confidence: 99%

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confidence: 99%

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The Hypothalamic-Pituitary-Adrenal Axis in Pregnancy: Challenges in Disease Detection and Treatment

2005

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“…There are many dilemmas in the treatment of a patient suffering from type 1 diabetes and other autoimmune endocrinopathy(ies). It is difficult to balance the appropriate management of diabetes with other endocrinologi-cal replacement therapies ± mainly during pregnancy (Gaither et al, 1998;Roth et al, 1990).…”

Section: Introductionmentioning

confidence: 99%

Pregnancy in a Woman Suffering from Type 1 Diabetes Associated with Addison's Disease and Hashimoto's Thyroiditis (Fully Developed Autoimmune Polyglandular Syndrome Type 2)

Stechova¹,

Bartášková²,

Mrstinova³

et al. 2004

Exp Clin Endocrinol Diabetes

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In this article the pregnancy of a woman suffering from the complete triad typical of Autoimmune Polyglandular Syndrome Type 2 (Addison's disease + type 1 diabetes + Hashimoto's thyroiditis) is reported. By using insulin pump therapy with insulin lispro, it was possible to balance diabetes control with changes of steroid replacement therapy. Pregnancy was uneventful until week 27, when signs of preeclampsia occurred. The boy was born without difficulty at gestational age 37 weeks by planned cesarean section but signs of diabetic fetopathy (macrosomia, hypoglycaemia and hypocalcaemia) were expressed. He required a short course of hydrocortisone therapy. He made a good and rapid recovery. The mother made a good post-operative recovery too, but 4 months after the delivery microalbuminuria as well as mild hyperuricemia are still present. Interdisciplinary approach and very careful observation of the mother as well as of the child enabled successful outcome of this highly risky pregnancy.

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“…PAG may develop during pregnancy or postpartum, as demonstrated in patient no. 1, 8 a feature that is shared with some of the autoimmune CTD such as systemic lupus.…”

mentioning

confidence: 99%

Polyglandular autoimmune syndrome type II (Schmidt's syndrome) in patients with autoimmune connective tissue disorders

Wollina

Schreiber

2003

Acad Dermatol Venereol

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Pregnancy complicated by autoimmune polyglandular syndrome type II: A case report

Cited by 3 publications

References 0 publications

The Hypothalamic-Pituitary-Adrenal Axis in Pregnancy: Challenges in Disease Detection and Treatment

The Hypothalamic-Pituitary-Adrenal Axis in Pregnancy: Challenges in Disease Detection and Treatment

Pregnancy in a Woman Suffering from Type 1 Diabetes Associated with Addison's Disease and Hashimoto's Thyroiditis (Fully Developed Autoimmune Polyglandular Syndrome Type 2)

Polyglandular autoimmune syndrome type II (Schmidt's syndrome) in patients with autoimmune connective tissue disorders

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