Abstract
Appropriate management of adrenal insufficiency in pregnancy is challenging due to the rarity of both primary, secondary, and tertiary forms of the disease and the lack of evidence-based recommendations to guide clinicians to glucocorticoid and sometimes also mineralocorticoid dosage adjustments. Debut of adrenal insufficiency during pregnancy requires immediate diagnosis as it can lead to adrenal crisis, intrauterine growth restriction, and foetal demise. Diagnosis is difficult due to the overlap of symptoms of adrenal insufficiency and its crisis with those of pregnancy. Adrenal insufficiency in stable replacement treatment needs careful monitoring during pregnancy to adapt to the physiological changes in the requirements of the adrenal hormones. This is hampered because the diagnostic threshold of most adrenocortical hormones is not applicable during pregnancy. The frequent use of assisted reproduction technology with controlled ovarian hyperstimulation in these patient groups with disease-induced low fertility has created an unrecognised risk of adrenal crises due to accelerated oestrogen stimulation with an increased risk of even life-threatening complications for both the woman and foetus. The area needs consensus recommendations between gynaecologists and endocrinologists in tertiary referral centres to alleviate such increased gestational risk. Patient and partner education and the use of the EU emergency card for the management of adrenal crises can also contribute to better pregnancy outcomes. There is a strong need for more research on, for example, the improvement of glucocorticoid replacement as well as crisis management treatment and biomarkers for treatment optimization in this field, which suffers from the rare nature of the diseases and poor funding.
Originalsprog | Engelsk |
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Tidsskrift | European Journal of Endocrinology |
Vol/bind | 190 |
Udgave nummer | 1 |
Sider (fra-til) | R10-R20 |
Antal sider | 11 |
ISSN | 0804-4643 |
DOI | |
Status | Udgivet - 2024 |
Bibliografisk note
Funding Information:Ulla Feldt-Rasmussen, MD, DMSc, is Emerita Professor and Senior Researcher at the Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University, Denmark. She has published >520 papers in peer-reviewed journals and many textbook chapters on, for example, thyroid hormones and body composition, thyroid autoimmunity and cancer, cytokines as regulators of endocrine cells, thyroid-disrupting chemicals, hypopituitarism after traumatic brain injury, glucocorticoid-induced adrenal insufficiency, accuracy of endocrine testing, adolescent transition to adult care, pregnancy, and endocrine conditions. She has organised international meetings and courses and led European and other collaborations in endocrinology. Professor Feldt-Rasmussen is a textbook and journal Editor of endocrine productions and belongs to many international professional organisations. She is a recipient of many prizes: ETA Pinchera Prize, Mayo Clinic’s Haynes Lecturer’s Award, and Bror-Axel Lamberg’s thyroid research award. Acknowledgments
Publisher Copyright:
© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Endocrinology.