Royal College of Surgeons in Ireland
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Fertility and pregnancy in adrenal insufficiency

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journal contribution
posted on 2024-03-19, 10:19 authored by Deirdre Green, Rosemary Dineen, Michael O'ReillyMichael O'Reilly, Mark SherlockMark Sherlock

Despite the availability of adrenal hormone replacement therapy, patients with adrenal insufficiency can be affected by reduced fertility and parity. Patients with well-managed adrenal insufficiency are expected to have uneventful pregnancies and favourable outcomes, but an increased risk of maternal and neonatal complications has been reported in some cases. Many physiological changes occur to the hypothalamic-pituitary-adrenal (HPA) axis during pregnancy, often making a new diagnosis and management of adrenal insufficiency challenging. The management of adrenal insufficiency also needs to reflect the physiologic changes of pregnancy, often requiring increased doses of glucocorticoid as pregnancy progresses and in some circumstances mineralocorticoid replacement (in primary adrenal insufficiency patients only), especially in the third trimester. To date, there are no prospective data guiding management of adrenal insufficiency in pregnancy. In this review, we focus on the impact of adrenal insufficiency on fertility and parity based on the aetiology of adrenal insufficiency and provide a practical approach to the management of patients with adrenal insufficiency before and during pregnancy. 

Funding

HRB Emerging Clinician Scientist award (ECSA-2020-001)

RCSI-Strategic academic appointment award

History

Comments

The original article is available at https://ec.bioscientifica.com/

Published Citation

Green D, Dineen R, O'Reilly MW, Sherlock M. Fertility and pregnancy in adrenal insufficiency. Endocr Connect. 2024;13(2):e230088.

Publication Date

12 January 2024

PubMed ID

38038998

Department/Unit

  • Medicine
  • Beaumont Hospital

Publisher

Bioscientifica Ltd

Version

  • Published Version (Version of Record)