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.

Current management and outcome of pregnancies in women with adrenal insufficiency: experience from a multicenter survey / Bothou, C.; Anand, G.; Li, D.; Kienitz, T.; Seejore, K.; Simeoli, C.; Ebbehoj, A.; Ward, E. G.; Paragliola, R. M.; Ferrigno, R.; Badenhoop, K.; Bensing, S.; Oksnes, M.; Esposito, D.; Bergthorsdottir, R.; Drake, W.; Wahlberg, J.; Reisch, N.; Hahner, S.; Pearce, S.; Trainer, P.; Etzrodt-Walter, G.; Thalmann, S. P.; Saevik, A. B.; Husebye, E.; Isidori, A. M.; Falhammar, H.; Meyer, G.; Corsello, S. M.; Pivonello, R.; Murray, R.; Bancos, I.; Quinkler, M.; Beuschlein, F.. - In: THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM. - ISSN 0021-972X. - 105:8(2020), pp. E2853-E2863. [10.1210/clinem/dgaa266]

Current management and outcome of pregnancies in women with adrenal insufficiency: experience from a multicenter survey

Isidori A. M.;Pivonello R.;
2020

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.
2020
addison disease; adrenal crisis; congenital adrenal hyperplasia; glucocorticoid; mineralocorticoid; miscarriage; pregnancy
01 Pubblicazione su rivista::01a Articolo in rivista
Current management and outcome of pregnancies in women with adrenal insufficiency: experience from a multicenter survey / Bothou, C.; Anand, G.; Li, D.; Kienitz, T.; Seejore, K.; Simeoli, C.; Ebbehoj, A.; Ward, E. G.; Paragliola, R. M.; Ferrigno, R.; Badenhoop, K.; Bensing, S.; Oksnes, M.; Esposito, D.; Bergthorsdottir, R.; Drake, W.; Wahlberg, J.; Reisch, N.; Hahner, S.; Pearce, S.; Trainer, P.; Etzrodt-Walter, G.; Thalmann, S. P.; Saevik, A. B.; Husebye, E.; Isidori, A. M.; Falhammar, H.; Meyer, G.; Corsello, S. M.; Pivonello, R.; Murray, R.; Bancos, I.; Quinkler, M.; Beuschlein, F.. - In: THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM. - ISSN 0021-972X. - 105:8(2020), pp. E2853-E2863. [10.1210/clinem/dgaa266]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1557023
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