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Adrenal disease in pregnancy.
1Adrenal Steroid Disorders Group, Division of Pediatric Endocrinology, Mount Sinai School of Medicine, New York, NY 10029, USA. oksana.lekarev@mssm.edu
Best Practice & Research. Clinical Endocrinology & Metabolism
|November 26, 2011
Summary
Adrenal disorders during pregnancy are rare but serious. Diagnosis is complex due to pregnancy-induced hormonal changes, requiring careful assessment of conditions like Cushing's syndrome and adrenal insufficiency.
Area of Science:
- Endocrinology
- Obstetrics
- Reproductive Medicine
Background:
- Adrenal disorders in pregnancy present diagnostic challenges due to altered maternal endocrine metabolism and overlapping symptoms with pregnancy.
- Pregnancy can mask or mimic signs of adrenal conditions, complicating accurate diagnosis and management.
Purpose of the Study:
- To review the diagnosis and management of common adrenal disorders during pregnancy, including Cushing's syndrome, adrenal insufficiency, and congenital adrenal hyperplasia.
- To highlight the unique physiological changes in pregnancy that affect adrenal hormone levels and diagnostic interpretation.
Main Methods:
- Review of current literature on adrenal disorders in pregnancy.
- Analysis of diagnostic criteria and treatment strategies for specific conditions.
- Discussion of hormonal changes during pregnancy and their impact on diagnosis.
Main Results:
- Adrenal adenoma is the most frequent cause of Cushing's syndrome in pregnancy; surgical treatment is generally preferred.
- Exogenous corticosteroid use is the leading cause of adrenal insufficiency; hydrocortisone is the recommended treatment.
- Congenital adrenal hyperplasia (21-hydroxylase deficiency) is managed with hydrocortisone, with prenatal dexamethasone used selectively for at-risk female fetuses.
Conclusions:
- Accurate diagnosis of adrenal disorders in pregnancy requires understanding pregnancy-specific physiological adaptations.
- Management strategies must consider maternal and fetal well-being, with specific treatments tailored to each condition.
- Hydrocortisone is the preferred glucocorticoid replacement, while dexamethasone has a role in prenatal treatment of congenital adrenal hyperplasia.
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