Treatment of endocrine diseases.

Abstract

Conn's syndrome, is rare but may be suspected in patients with hypertension and hypokalaemia. The hypertension is rarely severe and full investigation may be postponed until after pregnancy, when localisation procedures such as the use of radio labelled selenium cholesterol may be used without fear of affecting the fetus. Cushing's syndrome?Though rare, glucocorticoid excess presenting in pregnancy is much more serious, and needs urgent investigation because of the high risk (16%) of malignancy of the adrenal cortex.5 Dexamethasone crosses the placenta, causing suppression of the fetal pituitary-adrenal axis,6 but in the doses used for diagnosis this suppression is short lived. The use of metyrapone is discussed in the section on management. Pituitary disorders?Investigation of pituitary disorders usually includes assessing the response to insulin induced hypoglycaemia. The transient nature of the hypoglycaemia is without serious risk to the fetus. The usual precautions of having an intravenous line open, with hydrocortisone and dextrose drawn up ready, as well as using a smaller dose of insulin for patients with suspected hypopituitarism, apply in pregnancy as much as for non-pregnant patients.