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MINERVA ENDOCRINOLOGICA

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Minerva Endocrinologica 2018 Mar 15

DOI: 10.23736/S0391-1977.18.02840-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Secondary adrenal insufficiency in pregnancy: any differences?

Stephan PETERSENN

ENDOC Center for Endocrine Tumors, Hamburg, Germany


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Secondary adrenal insufficiency may pose specific challenges during pregnancy. The interpretation of diagnostic tests is hindered by physiological adaptations of the HPA axis. Due the relevant increases in CBG, 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: Secondary adrenal insufficiency - Pregnancy - Pituitary disease

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Publication History

Article first published online: March 15, 2018
Manuscript accepted: March 13, 2018
Manuscript received: March 12, 2018

Per citare questo articolo

Petersenn S. Secondary adrenal insufficiency in pregnancy: any differences?. Minerva Endocrinol 2018 Mar 15. DOI: 10.23736/S0391-1977.18.02840-7

Corresponding author e-mail

stephan.petersenn@endoc-med.de