This blogpost is about the Adrenal Disease and Pregnancy. The points have been taken from a TOG article which was published in October 2021. The article covers this topic quite comprehensively. It is recommended to read the original article for complete understanding of this important exam topic. I hope you find this post helpful.
To download the original article: Click Here
To access ALL TOGs List: Click Here
 |
| www.rubabk4courses.com |
Introduction
- Adrenal disease in pregnancy is rare
- Challenging to diagnose
- Associated with ↑ adverse outcomes for both mother & fetus
- Timely diagnosis & MDT involvement are essential to manage these high risk pregnancies
Major Adrenal Disorders
- Primary Adrenocortical Insufficiency (Addisons’s Disease)
- Cushing’s Syndrome
- Primary Aldosteronism (PA)
- Congenital Hyperplasia (CAH)
- Pheochromocytoma & Paraganglioma (PPGL)
Primary Adrenocortical Insufficiency (Addisons’s Disease)
Adrenal insufficiency (AI) classified → primary, secondary & tertiary
Primary Insufficiency in Pregnancy
- Uncommon 1 in 3000 to 5.5 in 100 000 pregnancies
- Results due to adrenocortical disease
- Both Glucocorticoid (GC) & Mineralocorticoid (MC) deficiency
- 70-90% due to autoimmune atrophy of adrenal gland
Secondary Insufficiency associated with ACTH secretion disorders mainly cortisol deficiency
Tertiary Insufficiency associated with CRH secretion disorders mainly cortisol deficiency
Cortisol during pregnancy
- ↑ Levels Both free & total cortisol
- Peaks at 26th weeks
- Diurnal rhythmic variation is maintained
 |
| Ref: TOG |
Diagnosis
- Females with Primary AI → lower fertility rates
- Most diagnosed before pregnancy & are already on GC & MC
- Challenging to diagnose for the 1st time in pregnancy as overlap of physiological symptoms of pregnancy
- Highly Suggestive Features → hyperpigmentation on mucous membranes, extensor surfaces & non exposed regions
Short Synacthen stimulation Test
- Non-pregnant → diagnosis likely if morning cortisol <140 nmol/L along with ↑ ACTH
- Pregnant → this cut-off not reliable as most women have values >555 nmol/L in 2nd /3rd tri
- Offer treatment if indeterminate SST & retest after delivery
Salivary free cortisol
In pregnancy → consistent, generalisable & rationale measure of adrenal function
