Current Management and Outcome of Pregnancies in Women With Adrenal Insufficiency: Experience from a Multicenter Survey.

Abstract

CONTEXT:

Appropriate management of adrenal insufficiency (AI) in pregnancy can be challenging due to the rarity of the disease and lack of evidence-based recommendations to guide glucocorticoid and mineralocorticoid dosage adjustment.

OBJECTIVE:

Multicenter survey on current clinical approaches in managing AI during pregnancy.

DESIGN:

Retrospective anonymized data collection from 19 international centers from 2013 to 2019.

SETTING AND PATIENTS:

128 pregnancies in 113 women with different causes of AI: Addison disease (44%), secondary AI (25%), congenital adrenal hyperplasia (25%), and acquired AI due to bilateral adrenalectomy (6%).

RESULTS:

Hydrocortisone (HC) was the most commonly used glucocorticoid in 83% (97/117) of pregnancies. Glucocorticoid dosage was increased at any time during pregnancy in 73/128 (57%) of cases. In these cases, the difference in the daily dose of HC equivalent between baseline and the third trimester was 8.6 ± 5.4 (range 1-30) mg. Fludrocortisone dosage was increased in fewer cases (7/54 during the first trimester, 9/64 during the second trimester, and 9/62 cases during the third trimester). Overall, an adrenal crisis was reported in 9/128 (7%) pregnancies. Cesarean section was the most frequent mode of delivery at 58% (69/118). Fetal complications were reported in 3/120 (3%) and minor maternal complications in 15/120 (13%) pregnancies without fatal outcomes.

CONCLUSIONS:

This survey confirms good maternal and fetal outcome in women with AI managed in specialized endocrine centers. An emphasis on careful endocrine follow-up and repeated patient education is likely to have reduced the risk of adrenal crisis and resulted in positive outcomes.

• Authors: Christina Bothou, Gurpreet Anand, Dingfeng Li, Tina Kienitz, Khyatisha Seejore, Chiara Simeoli, Andreas Ebbehoj, Emma G Ward, Rosa Maria Paragliola, Rosario Ferrigno, Klaus Badenhoop, Sophie Bensing, Marianne Oksnes, Daniela Esposito, Ragnhildur Bergthorsdottir, William Drake, Jeanette Wahlberg, Nicole Reisch, Stefanie Hahner, Simon Pearce, Peter Trainer, Gwendolin Etzrodt-Walter, Sébastien P Thalmann, Åse B Sævik, Eystein Husebye, Andrea M Isidori, Henrik Falhammar, Gesine Meyer, Salvatore M Corsello, Rosario Pivonello, Robert Murray, Irina Bancos, Marcus Quinkler, Felix Beuschlein
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 105 Issue 8 (08 01 2020) ISSN: 1945-7197 [Electronic] United States
• PMID: 32424397 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © Endocrine Society 2020. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Glucocorticoids
• Mineralocorticoids
• Fludrocortisone
• Hydrocortisone

Topics

• Adrenal Insufficiency (diagnosis, drug therapy, etiology)
• Adult
• Cesarean Section (statistics & numerical data)
• Dose-Response Relationship, Drug
• Female
• Fludrocortisone (administration & dosage, adverse effects)
• Glucocorticoids (administration & dosage, adverse effects)
• Hormone Replacement Therapy (adverse effects, methods)
• Humans
• Hydrocortisone (administration & dosage, adverse effects)
• Mineralocorticoids (administration & dosage, adverse effects)
• Pregnancy
• Pregnancy Complications (drug therapy, etiology)
• Pregnancy Outcome
• Retrospective Studies
• Severity of Illness Index
• Treatment Outcome