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

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

Bothou, Christina (författare): Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland,Univ Spital Zurich, Switzerland

Anand, Gurpreet (författare): Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland,Univ Spital Zurich, Switzerland

Li, Dingfeng (författare): Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA,Mayo Clin, MN 55905 USA

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Kienitz, Tina (författare): Endocrinology in Charlottenburg, Berlin, Germany,Endocrinol Charlottenburg, Germany

Seejore, Khyatisha (författare): Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, England,St James Univ Hosp, England

Simeoli, Chiara (författare): Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy,Univ Federico II Napoli, Italy

Ebbehoj, Andreas (författare): Department of Clinical Medicine, Department of Endocrinology and Diabetes, Aarhus University, Aarhus, Denmark,Aarhus Univ, Denmark

Ward, Emma G. (författare): Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, England,St James Univ Hosp, England

Paragliola, Rosa Maria (författare): 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

Ferrigno, Rosario (författare): Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy,Univ Federico II Napoli, Italy

Badenhoop, Klaus (författare): Department of Internal Medicine I, Division of Endocrinology, Diabetes and Metabolism, University Hospital, Frankfurt, Germany,Univ Hosp, Frankfurt, Germany

Bensing, Sophie (författare): Karolinska Institutet

Oksnes, Marianne (författare): 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

Esposito, Daniela (författare): Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition

Bergthorsdottir, Ragnhildur, 1971 (författare): Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition

Drake, William (författare): Department of Endocrinology, St Bartholomew’s Hospital, London, UK,St Bartholomews Hosp, England

Wahlberg, Jeanette, 1969- (författare): Linköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Endokrinmedicinska kliniken

Reisch, Nicole (författare): Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany

Hahner, Stefanie (författare): Department of Internal Medicine I, Endocrinology and Diabetes Unit, University Hospital of Würzburg, University of Würzburg, Germany

Pearce, Simon (författare): Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK,Newcastle Univ, England

Trainer, Peter (författare): The Christie NHS Foundation, MAHSC, Wilmslow Road, Manchester, England,Christie NHS Fdn, England

Etzrodt-Walter, Gwendolin (författare): Praxis Dr. Etzrodt-Walter Endokrinologiezentrum Ulm, Ulm, Germany,Praxis Dr Etzrodt Walter Endokrinol Zentrum Ulm, Germany

Thalmann, Sébastien P. (författare): Ärztezentrum Sihlcity, Zurich, Switzerland

Sævik, Åse B. (författare): Department of Clinical Science and K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Jonas Liesvei, Bergen, Norway,Univ Bergen, Norway

Husebye, Eystein (författare): Department of Clinical Science and K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Jonas Liesvei, Bergen, Norway,Univ Bergen, Norway

Isidori, Andrea M. (författare): Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy,Sapienza Univ Rome, Italy

Falhammar, Henrik (författare): Karolinska Institutet

Meyer, Gesine (författare): Department of Internal Medicine I, Division of Endocrinology, Diabetes and Metabolism, University Hospital, Frankfurt, Germany,Univ Hosp, Germany

Corsello, Salvatore M. (författare): 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

Pivonello, Rosario (författare): Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy,Univ Federico II Napoli, Italy

Murray, Robert (författare): Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, England,St James Univ Hosp, England

Bancos, Irina (författare): Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA,Mayo Clin, MN 55905 USA

Quinkler, Marcus (författare): Endocrinology in Charlottenburg, Berlin, Germany,Endocrinol Charlottenburg, Germany

Beuschlein, Felix (författare): 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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2020-05-19
2020
Engelska.
Ingår i: Journal of Clinical Endocrinology and Metabolism. - : Oxford University Press. - 0021-972X .- 1945-7197. ; 105:8

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Tidskriftsartikel (refereegranskat)

Abstract Ämnesord

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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.

Ämnesord

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)

Nyckelord

Addison disease
adrenal crisis
congenital adrenal hyperplasia
glucocorticoid
mineralocorticoid
miscarriage
pregnancy
Addison disease
adrenal crisis
congenital adrenal hyperplasia
glucocorticoid
mineralocorticoid
miscarriage
pregnancy

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Av lärosätet: Örebro universitet; Linköpings universitet; Karolinska Institutet; Göteborgs universitet

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