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Published on: September 15, 2017
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Adrenal insufficiency and pregnancy
Krystallenia I Alexandraki1, Gregory A Kaltsas2
12nd Department of Surgery, Aretaieio Hospital Athens, Medical School.
Summary
Adrenal insufficiency in pregnancy requires careful management with hydrocortisone replacement. While complications like preterm birth and adrenal crises can occur, current evidence shows no increased maternal or neonatal fatality.
Area of Science:
- Endocrinology
- Reproductive Medicine
- Maternal-Fetal Medicine
Background:
- Adrenal insufficiency disrupts the hypothalamic-pituitary-adrenal (HPA) axis.
- Pregnancy involves physiological glucocorticoid excess due to heightened HPA axis activity.
Purpose of the Study:
- To review current evidence on managing adrenal insufficiency during pregnancy.
- To analyze maternal and neonatal outcomes associated with this condition.
Main Methods:
- Review of recent multicenter study data (ENSAT).
- Analysis of real-life data on pregnant women with adrenal insufficiency.
- Comparison with previously published studies and current guidelines.
Main Results:
- Increased hydrocortisone and mineralocorticoid replacement therapy use.
- Elevated rates of cesarean section, preterm delivery, and adrenal crises.
- Peripartum and postpartum complications observed, but no maternal or neonatal deaths.
Conclusions:
- Current management aligns with guidelines, showing no increased fatality.
- Further prospective data are needed for precise therapeutic protocols and optimal dosing.
- Avoiding under- or over-replacement of glucocorticoids/mineralocorticoids is crucial.
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