Addison's disease in pregnancy

Gradden, Craig; Lawrence, David; Doyle, P. M.; Welch, CR

doi:10.1016/s0140-6736(05)71786-4

Cited by 22 publications

(25 citation statements)

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“…Untreated or mismanaged PAI results in high rates of adrenal crisis, maternal deaths and negative foetal consequences, i.e. intrauterine deaths, suboptimal birthweight and reduced foetal growth (58,59,60). However, if provided adequate hormonal replacement, the majority of women can expect uneventful pregnancies of normal duration and without maternal or foetal compromise (61,62,63,64).…”

Section: Parity and Pregnancy Outcomementioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Epidemiology, quality of life and complications of primary adrenal insufficiency: a review

Bensing

Hulting

Husebye

et al. 2016

European Journal of Endocrinology

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In this article, we review published studies covering epidemiology, natural course and mortality in primary adrenal insufficiency (PAI) or Addison's disease. Autoimmune PAI is a rare disease with a prevalence of 100-220 per million inhabitants. It occurs as part of an autoimmune polyendocrine syndrome in more than half of the cases. The patients experience impaired quality of life, reduced parity and increased risk of preterm delivery. Following a conventional glucocorticoid replacement regimen leads to a reduction in bone mineral density and an increase in the prevalence of fractures. Registry studies indicate increased mortality, especially evident in patients diagnosed with PAI at a young age and in patients with the rare disease autoimmune polyendocrine syndrome type-1. Most notably, unnecessary deaths still occur because of adrenal crises. All these data imply the need to improve the therapy and care of patients with PAI.

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Section: Parity and Pregnancy Outcomementioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Epidemiology, quality of life and complications of primary adrenal insufficiency: a review

Bensing

Hulting

Husebye

et al. 2016

European Journal of Endocrinology

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“…Laboratory findings can show hyponatremia and hyperkalemia, but during normal pregnancy a small reduction in serum sodium (5 mEq/L or less) can be seen. Severe hyponatremia and/or acidosis also raise the suspicion of AI (4,6). Fasting hypoglycemia, lymphocytosis, and eosinophilia are helpful in making a diagnosis; nevertheless, hyperkalemia is not always present.…”

Section: Discussionmentioning

confidence: 99%

Pregnancies associated with primary adrenal insufficiency

Fux-Otta

Mereshian

Iraci

et al. 2008

Fertility and Sterility

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“…To ensure evaluation of cases in the context of modern treatment, only cases dating 1976 onward were considered for inclusion (8,20,26,27,28,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52). This search identified 28 cases of primary AI, a case series with 17 cases of treated adrenocortical carcinoma patients, out of which 7 were included as they were on hydrocortisone treatment following surgical treatment (51) PAI (5) Y (2/5)…”

Section: Fertility and Preconceptional Considerationsmentioning

confidence: 99%

“…Gradden and colleagues reported on an abortion in the 11th week of pregnancy in a previously unknown case of primary AI, where the diagnosis was delayed as symptoms were initially thought to be related to hyperemesis of pregnancy (26). Furthermore, Otta and coworkers described one case of neonatal death from a mother with known primary AI occurring 20 h after birth due to acute cardiorespiratory failure (27).…”

Section: Outcome Of Pregnancies In Aimentioning

confidence: 99%

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

Anand

Beuschlein

2018

European Journal of Endocrinology

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With the introduction of hormonal substitution therapy in the 1950s, adrenal insufficiency (AI) has been turned into a manageable disease in pregnant women. In fact, in the light of glucocorticoid replacement therapy and improved obstetric care, it is realistic to expect good maternal and fetal outcomes in patients with AI. However, there are still a number of challenges such as establishing the diagnosis of AI in pregnant women and optimizing the treatment of AI and related comorbidities prior to as well as during pregnancy. Clinical and biochemical diagnoses of a new-onset AI may be challenging because of overlapping symptoms of normal pregnancy as well as pregnancy-induced changes in cortisol values. Physiological changes occurring during pregnancy should be taken into account while adjusting the substitution therapy. The high proportion of reported adrenal crisis in pregnant women with AI highlights persistent problems in this particular clinical situation. Due to the rarity of the disease, there is no prospective data-guiding management of pregnancy in patients with known AI. The aim of this review is to summarize the maternal and fetal outcomes based on recently published case reports in patients with AI and to suggest a practical approach to diagnose and manage AI in pregnancy.

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Addison's disease in pregnancy

Cited by 22 publications

References 0 publications

MANAGEMENT OF ENDOCRINE DISEASE: Epidemiology, quality of life and complications of primary adrenal insufficiency: a review

MANAGEMENT OF ENDOCRINE DISEASE: Epidemiology, quality of life and complications of primary adrenal insufficiency: a review

Pregnancies associated with primary adrenal insufficiency

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

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