REVIEW  HOW TO HANDLE PITUITARY DISEASE DURING PREGNANCY 

Minerva Endocrinologica 2018 December;43(4):446-50

DOI: 10.23736/S0391-1977.18.02840-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Secondary adrenal insufficiency in pregnancy: any differences?

Stephan PETERSENN ✉

ENDOC Center for Endocrine Tumors, Hamburg, Germany

Secondary adrenal insufficiency may pose specific challenges during pregnancy. The interpretation of diagnostic tests is hindered by physiological adaptations of the hypothalamic-pituitary-adrenal axis. Due the relevant increases in cortisol-binding globulin, measurement of salivary cortisol may be preferable, but lacks sufficiently established cut-offs both for early-morning evaluation and during dynamic testing. Hydrocortisone should be used for replacement to avoid overexposure of the fetus, with dose adjustments according to clinical judgement. To account for increased free cortisol levels during the course of pregnancy, hydrocortisone may be increased by 5-7.5 mg in the third trimester. Patients should be seen at least once every trimester. Counseling of patients is of special importance to manage hyperemesis and infections. For labor, sufficient stress doses need to be applied.

KEY WORDS: Adrenal insufficiency - Pregnancy - Pituitary disease