Management of Endocrinopathies in Pregnancy: A Review of Current Evidence

Calina, Daniela; Docea, Anca Oana; Golokhvast, Kirill S.; Sifakis, Stavros; Tsatsakis, Aristidis; Makrigiannakis, Antonis

doi:10.3390/ijerph16050781

Cited by 41 publications

(53 citation statements)

References 138 publications

(213 reference statements)

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“…To properly diagnose and treat thyroid dysfunction in women of reproductive age, especially during pregnancy, is of crucial value for public health [16].…”

Section: Discussionmentioning

confidence: 99%

Less Favorable Lipid Profile and Higher Prevalence of Thyroid Antibodies in Women of Reproductive Age with High-Normal TSH—Retrospective Study

Karbownik-Lewińska

Stępniak

Żurawska

et al. 2020

IJERPH

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High-normal TSH can be associated with metabolic abnormalities and infertility. Aims of this study are to analyze retrospectively if routinely measured blood laboratory and anthropometric parameters differ between women of reproductive age with TSH < 2.5 mIU/L and with TSH ≥ 2.5 mIU/L. Retrospective analysis was performed in 466 female inpatients, aged 13–51, hospitalized in an endocrine department. The group of 280 patients with normal thyroid tests (TSH 0.27-4.2 mIU/L; normal FT3 and FT4) was selected and it was divided into two subgroups, i.e., with TSH < 2.5 mIU/L and TSH ≥ 2.5 mIU/L (n = 66; 23.6%). After excluding patients on L-thyroxine treatment (n = 240), those with TSH ≥ 2.5 mIU/L constituted 22.92% (n = 55). In the group of 280 patients with normal thyroid tests, an abnormally high concentration of triglycerides and an abnormally low HDLC/cholesterol ratio occurred more frequently in women with TSH ≥ 2.5 mIU/L than those with TSH < 2.5 mIU/L (17% vs. 7%, p = 0.017; 14% vs. 5%, p = 0.015, respectively). Increased concentration of thyroid antibodies, i.e., TPOAb, occurred more frequently in patients with TSH ≥ 2.5 mIU/L than those with TSH < 2.5 mIU/L (27% vs. 9%, p = 0.001). The same differences were found in the group of 240 patients after excluding those on L-thyroxine treatment. Blood lymphocyte concentration was the only independent linear parameter associated with TSH ≥ 2.5 mIU/L (OR = 1.551, p = 0.024) but only in the group of 280 patients with normal thyroid tests. TSH concentration correlated positively with blood lymphocyte (r = 0.129, p = 0.031) and TPOAb (r = 0.177, p = 0.005) concentrations but only in the group of 280 patients with normal thyroid tests. Less favorable lipid profiles and a higher prevalence of thyroid antibodies in women of reproductive age with high-normal TSH suggests that L-thyroxine treatment should be considered in such patients. The significance of a positive association between high-normal TSH and blood lymphocytes requires further evaluation.

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“…To properly diagnose and treat thyroid dysfunction in women of reproductive age, especially during pregnancy, is of crucial value for public health [16].…”

Section: Discussionmentioning

confidence: 99%

Less Favorable Lipid Profile and Higher Prevalence of Thyroid Antibodies in Women of Reproductive Age with High-Normal TSH—Retrospective Study

Karbownik-Lewińska

Stępniak

Żurawska

et al. 2020

IJERPH

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“…Pregnancy induces profound changes in endocrine functions that affect not only the gonadotropic axis (increase in oestrogens, progesterone and androgens), hormones of lactation (increase in oxytocin and prolactin) and placental hormones (notably human chorionic gonadotropin: HCG), but also other endocrine glands such as the adrenal and thyroid glands. This can lead to false interpretation of hormonal assessments during pregnancy, while most endocrine disorders have heavy consequences on foetal development (197). The deleterious effects of obesity on pregnancy outcomes have been widely described (198).…”

Section: Pregnancymentioning

confidence: 99%

“…The foeto-placental unit produces large amounts of steroid and peptide hormones including CRH. The increase in CBG (200), result in a two to threefold increase of plasma cortisol levels and a lesser increase in free cortisol (197). The usual tests are not as easy to interpret during pregnancy.…”

Section: Gonadsmentioning

confidence: 99%

“…Renin-angiotensin-aldosterone (RAA) axis is activated during pregnancy to compensate vasodilation and to increase extracellular fluid volume. Because, during pregnancy, urine and plasma aldosterone increase, biochemical test results must be correlated with the normal values for pregnancy (197). Alterations of RAA axis have been incriminated in the pathophysiology of preeclampsia that is more prevalent in obese pregnant women.…”

Section: Gonadsmentioning

confidence: 99%

“…GH decreases during pregnancy but IGF1 increases because of placental growth hormone production (197). Obesity can further decrease GH, but the consequences are not known.…”

Section: Gonadsmentioning

confidence: 99%

See 2 more Smart Citations

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

Pasquali

Casanueva

Haluzı́k

et al. 2020

European Journal of Endocrinology

135

156

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Obesity is an emerging condition, with a prevalence of ~20%. Although the simple measurement of BMI is likely a simplistic approach to obesity, BMI is easily calculated, and there are currently no data showing that more sophisticated methods are more useful to guide the endocrine work-up in obesity. An increased BMI leads to a number of hormonal changes. Additionally, concomitant hormonal diseases can be present in obesity and have to be properly diagnosed – which in turn might be more difficult due to alterations caused by body fatness itself. The present European Society of Endocrinology Clinical Guideline on the Endocrine Work-up in Obesity acknowledges the increased prevalence of many endocrine conditions in obesity. It is recommended to test all patients with obesity for thyroid function, given the high prevalence of hypothyroidism in obesity. For hypercortisolism, male hypogonadism and female gonadal dysfunction, hormonal testing is only recommended if case of clinical suspicion of an underlying endocrine disorder. The guideline underlines that weight loss in obesity should be emphasized as key to restoration of hormonal imbalances and that treatment and that the effect of treating endocrine disorders on weight loss is only modest.

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Successful pregnancy and delivery in a female with pituitary stalk interruption syndrome following in vitro fertilization and embryo transfer: A case report and literature review

Zhang,

Liu,

Zhou

et al. 2023

Intl J Gynecology & Obste

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Pituitary stalk interruption syndrome (PSIS) in female patients is mainly characterized by short stature, primary amenorrhea, absent or incomplete sexual maturation, and infertility. Successful pregnancies among these patients are rare. In this report, we describe a successful pregnancy and delivery in a 28‐year‐old Chinese woman with PSIS following in vitro fertilization and embryo transfer. The patient exhibited typical symptoms, including multiple pituitary hormone deficiency, typical triad signs in magnetic resonance imaging (MRI), undetectable serum gonadotropins and estradiol levels, and invisible antral follicles in both ovaries. During the first attempted controlled ovarian hyperstimulation cycle, 14 oocytes were retrieved and six embryos were acquired. Artificial endometrial preparation and frozen–thawed embryo transfer were performed, resulting in a clinical pregnancy after the transfer of a day 5 blastocyst. The patient was closely monitored throughout the pregnancy and multiple hormone dosages were modulated accordingly. She delivered a healthy boy by elective cesarean section, and the newborn developed normally during a 1‐year follow‐up period. This is the first report of a successful live birth in a woman with PSIS achieved through in vitro fertilization and frozen–thawed embryo transfer. A literature review on this topic is also presented.

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Management of Endocrinopathies in Pregnancy: A Review of Current Evidence

Cited by 41 publications

References 138 publications

Less Favorable Lipid Profile and Higher Prevalence of Thyroid Antibodies in Women of Reproductive Age with High-Normal TSH—Retrospective Study

Less Favorable Lipid Profile and Higher Prevalence of Thyroid Antibodies in Women of Reproductive Age with High-Normal TSH—Retrospective Study

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

Successful pregnancy and delivery in a female with pituitary stalk interruption syndrome following in vitro fertilization and embryo transfer: A case report and literature review

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