Melanoderma Revealing Primary Antiphospholipid Syndrome

Guibal, F.; Rybojad, M.; Cordoliani, F.; Jaccard, Alexandre Phillipe Boss; Sarfaty, E.; Morel, Penelope A.; Clauvel, Jean‐Pierre

doi:10.1159/000246323

Cited by 7 publications

(11 citation statements)

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“…Many of these reported cases occurred in previously unrecognized cases or prior to the availability of modern glucocorticoid regimens (265,270,271). While there have been several reports of women with AI presenting during gestation with previous recurrent or subsequent abortions there does not appear to be an increased risk from AI alone, when appropriately treated (229,(272)(273)(274). Of note, several such cases were associated with positive anticardiolipin antibodies or circulating lupus anticoagulant (272)(273)(274).…”

Section: Maternal and Fetal Morbidity And Mortalitymentioning

confidence: 99%

“…While there have been several reports of women with AI presenting during gestation with previous recurrent or subsequent abortions there does not appear to be an increased risk from AI alone, when appropriately treated (229,(272)(273)(274). Of note, several such cases were associated with positive anticardiolipin antibodies or circulating lupus anticoagulant (272)(273)(274). Furthermore, adverse effects of associated conditions including diabetes likely contributed to fetal morbidity or mortality in other reports (228).…”

Section: Maternal and Fetal Morbidity And Mortalitymentioning

confidence: 99%

“…An ACTH level above 100 pg/ml (22 pmol/l) is generally consistent with primary AI, even in late pregnancy (281). In primary AI in pregnancy elevated ACTH levels in the range of 400-2000 pg/ml (88-440 pmol/l) have been reported (219,264,274). However ACTH levels fluctuate widely day to day and a single value cannot be relied upon for diagnosis of either primary or secondary AI (266).…”

Section: Differentiation Of Primary and Secondary Adrenal Insufficiencymentioning

confidence: 99%

“…Patients with positive adrenal antibodies have an autoimmune etiology and do not require imaging. Imaging of the adrenal glands can detect the large glands associated with tuberculous or fungal infection, bilateral metastases, hemorrhage or infarction (274,277,305). Ultrasound imaging is safe but may have limited resolution.…”

Section: Imagingmentioning

confidence: 99%

“…presence of other potentially associated organ specific autoimmune disease such as type 1 diabetes or vitiligo should raise clinical suspicion of AI in the presence of typical symptoms(228)(229)(230)(231)265). Severe abdominal pain associated with increased pigmentation (melanoderma) may herald the onset of AI, and the possibility of acute adrenal hemorrhage should be considered(274). In some cases the presentation is associated with persistent vomiting that can be associated with or confused with hyperemesis gravidarum, potentially leading to a fatal outcome if left undiagnosed(264).…”

mentioning

confidence: 99%

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The Hypothalamic-Pituitary-Adrenal Axis in Pregnancy: Challenges in Disease Detection and Treatment

2005

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Pregnancy dramatically affects the hypothalamic-pituitary-adrenal axis leading to increased circulating cortisol and ACTH levels during gestation, reaching values in the range seen in Cushing's syndrome (CS). The cause(s) of increased ACTH may include placental synthesis and release of biologically active CRH and ACTH, pituitary desensitization to cortisol feedback, or enhanced pituitary responses to corticotropin-releasing factors. In this context, challenges in diagnosis and management of disorders of the hypothalamic-pituitary-adrenal axis in pregnancy are discussed. CS in pregnancy is uncommon and is associated with fetal morbidity and mortality. The diagnosis may be missed because of overlapping clinical and biochemical features in pregnancy. The proportion of patients with primary adrenal causes of CS is increased in pregnancy. CRH stimulation testing and inferior petrosal sinus sampling can identify patients with Cushing's disease. Surgery is a safe option for treatment in the second trimester; otherwise medical therapy may be used. Women with known adrenal insufficiency that is appropriately treated can expect to have uneventful pregnancies. Whereas a fetal/placental source of cortisol may mitigate crisis during gestation, unrecognized adrenal insufficiency may lead to maternal or fetal demise either during gestation or in the puerperium. Appropriate treatment and management of labor are reviewed.

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Section: Maternal and Fetal Morbidity And Mortalitymentioning

confidence: 99%

Section: Maternal and Fetal Morbidity And Mortalitymentioning

confidence: 99%

Section: Differentiation Of Primary and Secondary Adrenal Insufficiencymentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

mentioning

confidence: 99%

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The Hypothalamic-Pituitary-Adrenal Axis in Pregnancy: Challenges in Disease Detection and Treatment

2005

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Adrenal insufficiency in pregnancy: challenging issues in diagnosis and management

2013

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Adrenal insufficiency (AI) in pregnancy is relatively rare, but it is associated with significant maternal and fetal morbidity and mortality if untreated during gestation or in the puerperium. Hence, timely diagnosis and decisive treatment by the clinician are critical. However, due to pregnancy-induced metabolic and endocrine changes and the resemblance of symptomatology of AI to those of pregnancy, the diagnosis is often difficult to recognize and challenging to confirm. Normal pregnancy is a state of glucocorticoid excess particularly in the latter stages, and normative values for serum cortisol levels are not well-established. Furthermore, testing the hypothalamic-pituitary-adrenal axis using validated stimulation tests during pregnancy are lacking. Therefore, it is the aim of the present review to discuss and to summarize the current knowledge, focussing on the challenges in recognizing AI in pregnancy and interpreting the diagnostic tests, and to propose a clinical approach for optimizing the management of AI in women diagnosed before or during pregnancy.

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Adrenal Disorders in Pregnancy

Lindsay

Nieman

2006

Endocrinology and Metabolism Clinics of North America

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Melanoderma Revealing Primary Antiphospholipid Syndrome

Cited by 7 publications

References 0 publications

The Hypothalamic-Pituitary-Adrenal Axis in Pregnancy: Challenges in Disease Detection and Treatment

The Hypothalamic-Pituitary-Adrenal Axis in Pregnancy: Challenges in Disease Detection and Treatment

Adrenal insufficiency in pregnancy: challenging issues in diagnosis and management

Adrenal Disorders in Pregnancy

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