Current management and outcome of pregnancies in women with adrenal insufficiency: experience from a multi-center survey

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  • Christina Bothou, Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland.
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  • Gurpreet Anand, Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland.
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  • Dingfeng Li, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.
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  • Tina Kienitz, Endocrinology in Charlottenburg, Berlin, Germany.
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  • Khyatisha Seejore, Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, U.K.
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  • Chiara Simeoli, Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy.
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  • Andreas Ebbehoj
  • Emma G Ward, Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, U.K.
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  • Rosa Maria Paragliola, Unit of Endocrinology, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
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  • Rosario Ferrigno, Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy.
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  • Klaus Badenhoop, Department of Internal Medicine I, Division of Endocrinology, Diabetes and Metabolism, University Hospital, Frankfurt, Germany.
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  • Sophie Bensing, Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Endocrinology, Inflammation and Infection Theme, Karolinska University Hospital, Stockholm, Sweden.
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  • Marianne Oksnes, Department of Clinical Science and K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Jonas Liesvei 65, N-5021 Bergen, Norway.
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  • Daniela Esposito, Department of Endocrinology, Sahlgrenska, University Hospital, 413 45 Gothenburg, Sweden.
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  • Ragnhildur Bergthorsdottir, Department of Endocrinology, Sahlgrenska, University Hospital, 413 45 Gothenburg, Sweden.
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  • William Drake, Department of Endocrinology, St Bartholomew's Hospital, London EC1A 7BE, UK.
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  • Jeanette Wahlberg, Department of Endocrinology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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  • Nicole Reisch, Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany.
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  • Stefanie Hahner, Department of Internal Medicine I, Endocrinology and Diabetes Unit, University Hospital of Würzburg, University of Würzburg, Germany.
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  • Simon Pearce, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, U.K.
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  • Peter Trainer, The Christie NHS Foundation, MAHSC, Wilmslow Road, Manchester M20 4BX, U.K.
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  • Gwendolin Etzrodt-Walter, Praxis Dr. Etzrodt-Walter Endokrinologiezentrum Ulm, Ulm, Germany.
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  • Sébastien P Thalmann, Ärztezentrum Sihlcity, Zurich, Switzerland.
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  • Åse B Sævik, Department of Clinical Science and K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Jonas Liesvei 65, N-5021 Bergen, Norway.
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  • Eystein Husebye, Department of Clinical Science and K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Jonas Liesvei 65, N-5021 Bergen, Norway.
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  • Andrea M Isidori, Department of Experimental Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Roma, Italy.
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  • Henrik Falhammar, Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Endocrinology, Inflammation and Infection Theme, Karolinska University Hospital, Stockholm, Sweden.
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  • Gesine Meyer, Department of Internal Medicine I, Division of Endocrinology, Diabetes and Metabolism, University Hospital, Frankfurt, Germany.
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  • Salvatore M Corsello, Unit of Endocrinology, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
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  • Rosario Pivonello, Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy.
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  • Robert Murray, Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, U.K.
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  • Irina Bancos, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.
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  • Marcus Quinkler, Endocrinology in Charlottenburg, Berlin, Germany.
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  • Felix Beuschlein, Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany.

Context: Appropriate management of adrenal insufficiency (AI) in pregnancy can be challenging due to the rarity of the disease and lack of evidence-based recommendations to guide glucocorticoid and mineralocorticoid dosage adjustment. Objective: Multicenter survey on current clinical approaches in managing AI during pregnancy. Design: Retrospective anonymized data collection from 19 international centers from 2013 to 2019. Setting and Patients: 128 pregnancies in 113 women with different causes of AI: Addison disease (44%), secondary AI (25%), congenital adrenal hyperplasia (25%), and acquired AI due to bilateral adrenalectomy (6%). Results: Hydrocortisone (HC) was the most commonly used glucocorticoid in 83% (97/117) of pregnancies. Glucocorticoid dosage was increased at any time during pregnancy in 73/128 (57%) of cases. In these cases, the difference in the daily dose of HC equivalent between baseline and the third trimester was 8.6 ± 5.4 (range 1-30) mg. Fludrocortisone dosage was increased in fewer cases (7/54 during the first trimester, 9/64 during the second trimester, and 9/62 cases during the third trimester). Overall, an adrenal crisis was reported in 9/128 (7%) pregnancies. Cesarean section was the most frequent mode of delivery at 58% (69/118). Fetal complications were reported in 3/120 (3%) and minor maternal complications in 15/120 (13%) pregnancies without fatal outcomes. Conclusions: This survey confirms good maternal and fetal outcome in women with AI managed in specialized endocrine centers. An emphasis on careful endocrine follow-up and repeated patient education is likely to have reduced the risk of adrenal crisis and resulted in positive outcomes.

OriginalsprogEngelsk
TidsskriftThe Journal of clinical endocrinology and metabolism
Vol/bind105
Nummer8
Sider (fra-til)E2853-E2863
Antal sider11
ISSN0021-972X
DOI
StatusUdgivet - aug. 2020

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