The function of the anterior pituitary-adrenal cortex axis in hyperemesis gravidarum

In order to study the function of the pituitary-adrenal axis, serum ACTH and cortisol levels were estimated before and after insulin induced hypoglycaemia in nine women with hyperemesis gravidarum, seven women in normal early pregnancy and in eight non-pregnant controls. Before hypoglycaemia, the basal ACTH level in the hyperemesis group (102-4+/-62-9 pg/ml) was higher than in normal early pregnancy (67-5+/-19-2 pg/ml; p less than 0-05) or in non-pregnant controls (54-8+/-25-2 pg/ml; less than 0-01). Correspondingly, the mean cortisol value in hyperemesis (0-47+/-0-16 mumol/l) was higher than in normal early pregnancy (0-39+/-0-10 mumol/l; p greater than 0-05) or in non-pregnant controls (0-32+/-0-13 mumol/l; p less than 0-01). After insulin the elevation of ACTH (p greater than 0-05) and cortisol (p less than 0-01) was observed in every group. The level of ACTH and cortisol was highest in hyperemesis group. Our results do not support the idea that hypofunction of the pituitary-adrenal axis contributes to the aetiology or pathogenesis of hyperemesis gravidarum. The high ACTH level might be evidence of the psychia instability of hyperemesis gravidarum patients.