Adrenal disease and pregnancy: an overview

Abstract

Key content Although uncommon, adrenal disorders in pregnancy are associated with severe complications, especially if undiagnosed or poorly managed. Some women are on long‐term steroids (especially those known to suffer from adrenal insufficiency) that suppress endogenous adrenal function. Under stress, these can become insufficient – particularly around labour and the puerperium. Adrenal insufficiency, for example, has been associated with maternal and fetal morbidity and mortality if untreated, while phaeochromocytoma is associated with considerable maternal mortality. Clinical features, diagnosis and management of the disorders of the adrenals in pregnancy are discussed, including Cushing’s syndrome, adrenal insufficiency, phaeochromocytoma and paragangliomas, primary aldosteronism and congenital adrenal hyperplasia. Learning objectives To understand the physiological changes in the adrenal system during pregnancy. To understand the clinical features of common adrenal problems in pregnancy and how they can be diagnosed and managed to minimise complications, especially acute adrenal insufficiency. To understand how the management of adrenal disorders is altered in pregnancy and the effect of adrenal diseases on pregnancy. Ethical issues Is there a role for in utero therapy if a prenatal diagnosis is made? Does treatment of the mother affect the fetus? Is optimal treatment of the mother limited by concerns for the fetus?