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Current Management and Outcome of Pregnancies in Women With Adrenal Insufficiency : Experience from a Multicenter Survey
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- Bothou, Christina (author)
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland,Univ Spital Zurich, Switzerland
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- Anand, Gurpreet (author)
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland,Univ Spital Zurich, Switzerland
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- Li, Dingfeng (author)
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA,Mayo Clin, MN 55905 USA
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- Kienitz, Tina (author)
- Endocrinology in Charlottenburg, Berlin, Germany,Endocrinol Charlottenburg, Germany
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- Seejore, Khyatisha (author)
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, England,St James Univ Hosp, England
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- Simeoli, Chiara (author)
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy,Univ Federico II Napoli, Italy
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- Ebbehoj, Andreas (author)
- Department of Clinical Medicine, Department of Endocrinology and Diabetes, Aarhus University, Aarhus, Denmark,Aarhus Univ, Denmark
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- Ward, Emma G. (author)
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, England,St James Univ Hosp, England
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- Paragliola, Rosa Maria (author)
- Unit of Endocrinology, Università Cattolica del Sacro Cuore – Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Univ Cattolica Sacro Cuore Fdn Policlin Univ Agos, Italy
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- Ferrigno, Rosario (author)
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy,Univ Federico II Napoli, Italy
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- Badenhoop, Klaus (author)
- Department of Internal Medicine I, Division of Endocrinology, Diabetes and Metabolism, University Hospital, Frankfurt, Germany,Univ Hosp, Frankfurt, Germany
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- Bensing, Sophie (author)
- Karolinska Institutet
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- Oksnes, Marianne (author)
- Endocrinology in Charlottenburg, Berlin, Germany; Department of Clinical Science and K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Jonas Liesvei, Bergen, Norway,Endocrinol Charlottenburg, Germany; Univ Bergen, Norway; Univ Bergen, Norway
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- Esposito, Daniela (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
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- Bergthorsdottir, Ragnhildur, 1971 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
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- Drake, William (author)
- Department of Endocrinology, St Bartholomew’s Hospital, London, UK,St Bartholomews Hosp, England
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- Wahlberg, Jeanette, 1969- (author)
- Linköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Endokrinmedicinska kliniken
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- Reisch, Nicole (author)
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
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- Hahner, Stefanie (author)
- Department of Internal Medicine I, Endocrinology and Diabetes Unit, University Hospital of Würzburg, University of Würzburg, Germany
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- Pearce, Simon (author)
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK,Newcastle Univ, England
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- Trainer, Peter (author)
- The Christie NHS Foundation, MAHSC, Wilmslow Road, Manchester, England,Christie NHS Fdn, England
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- Etzrodt-Walter, Gwendolin (author)
- Praxis Dr. Etzrodt-Walter Endokrinologiezentrum Ulm, Ulm, Germany,Praxis Dr Etzrodt Walter Endokrinol Zentrum Ulm, Germany
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- Thalmann, Sébastien P. (author)
- Ärztezentrum Sihlcity, Zurich, Switzerland
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- Sævik, Åse B. (author)
- Department of Clinical Science and K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Jonas Liesvei, Bergen, Norway,Univ Bergen, Norway
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- Husebye, Eystein (author)
- Department of Clinical Science and K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Jonas Liesvei, Bergen, Norway,Univ Bergen, Norway
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- Isidori, Andrea M. (author)
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy,Sapienza Univ Rome, Italy
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- Falhammar, Henrik (author)
- Karolinska Institutet
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- Meyer, Gesine (author)
- Department of Internal Medicine I, Division of Endocrinology, Diabetes and Metabolism, University Hospital, Frankfurt, Germany,Univ Hosp, Germany
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- Corsello, Salvatore M. (author)
- Unit of Endocrinology, Università Cattolica del Sacro Cuore – Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Univ Cattolica Sacro Cuore Fdn Policlin Univ Agos, Italy
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- Pivonello, Rosario (author)
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy,Univ Federico II Napoli, Italy
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- Murray, Robert (author)
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, England,St James Univ Hosp, England
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- Bancos, Irina (author)
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA,Mayo Clin, MN 55905 USA
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- Quinkler, Marcus (author)
- Endocrinology in Charlottenburg, Berlin, Germany,Endocrinol Charlottenburg, Germany
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- Beuschlein, Felix (author)
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland; Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany,Univ Spital Zurich, Switzerland; Klinikum Univ Munchen, Germany
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(creator_code:org_t)
- 2020-05-19
- 2020
- English.
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In: Journal of Clinical Endocrinology and Metabolism. - : Oxford University Press. - 0021-972X .- 1945-7197. ; 105:8
- Related links:
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https://urn.kb.se/re...
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Abstract
Subject headings
Close
- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
Keyword
- Addison disease
- adrenal crisis
- congenital adrenal hyperplasia
- glucocorticoid
- mineralocorticoid
- miscarriage
- pregnancy
- Addison disease
- adrenal crisis
- congenital adrenal hyperplasia
- glucocorticoid
- mineralocorticoid
- miscarriage
- pregnancy
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Bothou, Christin ...
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Anand, Gurpreet
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Li, Dingfeng
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Kienitz, Tina
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Seejore, Khyatis ...
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Simeoli, Chiara
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show more...
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Ebbehoj, Andreas
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Ward, Emma G.
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Paragliola, Rosa ...
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Ferrigno, Rosari ...
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Badenhoop, Klaus
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Bensing, Sophie
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Oksnes, Marianne
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Esposito, Daniel ...
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Bergthorsdottir, ...
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Drake, William
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Wahlberg, Jeanet ...
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Reisch, Nicole
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Hahner, Stefanie
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Pearce, Simon
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Trainer, Peter
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Etzrodt-Walter, ...
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Thalmann, Sébast ...
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Sævik, Åse B.
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Husebye, Eystein
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Isidori, Andrea ...
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Falhammar, Henri ...
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Meyer, Gesine
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Corsello, Salvat ...
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Pivonello, Rosar ...
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Murray, Robert
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Bancos, Irina
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Quinkler, Marcus
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Beuschlein, Feli ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Obstetrics Gynae ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Endocrinology an ...
- Articles in the publication
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Journal of Clini ...
- By the university
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Örebro University
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Linköping University
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Karolinska Institutet
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University of Gothenburg