Successful pregnancy outcome in a patient with primary Addison's disease

Abstract

A 32-year-old primigravida with primary Addison's disease was followed up from the early stages of pregnancy to delivery and puerperium by a multidisciplinary medical board. Besides fetal surveillance, great attention was given to steroid replacement therapy in order to avoid complications. Vaginal labor resulted in the birth of a healthy neonate that performed well.

Maternal and neonatal outcomes of pregnancies in women with Addison's disease: a population‐based cohort study on 7.7 million births

“…10,[25][26][27][28][29][30] The main Addison's treatments, hydrocortisone and fludrocortisone, are both classified as drug category C by the Food and Drugs Administration, meaning benefits probably outweigh the risks of teratogenicity. Case reports have either found fetal growth to be normal or to be restricted in women with Addison's disease.…”

“…10,26,27,30 It is hypothesised that the hypothalamic-pituitary-adrenal (HPA) axis plays an important role in the timing of parturition, and that corticotropin-releasing hormone levels may serve as a 'placental clock'. 10,26,27,30 It is hypothesised that the hypothalamic-pituitary-adrenal (HPA) axis plays an important role in the timing of parturition, and that corticotropin-releasing hormone levels may serve as a 'placental clock'.…”

“…Case reports have either found fetal growth to be normal or to be restricted in women with Addison's disease. 10,[25][26][27][28][29][30] The main Addison's treatments, hydrocortisone and fludrocortisone, are both classified as drug category C by the Food and Drugs Administration, meaning benefits probably outweigh the risks of teratogenicity. Some existing data show an association between corticosteroids and oral NS, not statistically significant; PPROM, premature preterm rupture of membranes.…”

“…In agreement with previous case studies and one population-based study, we found women with Addison's disease had a greater risk of preterm birth. 10,26,27,30 It is hypothesised that the hypothalamic-pituitary-adrenal (HPA) axis plays an important role in the timing of parturition, and that corticotropin-releasing hormone levels may serve as a 'placental clock'. 1,11,35 Therefore, dysfunction of the HPA axis in Addison's disease contributes to the increased risk of preterm delivery.…”

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

“…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)…”