Endocrine Abstracts

Successful pregnancy depends on the ability of the maternal immune system to tolerate a genetically incompatible feto-placental unit. One of the important adaptations leading to this immuno-tolerance is the shift, at implantation, of Th 1 dominance to Th 2 dominance. Successful pregnancy is a Th2 dominant immune state, therefore, it is not surprising that women with a Th 1 dominant immune disease such as rheumatoid arthritis, thyroiditis or multiple sclerosis improve during pregnancy, while patients suffering from Th 2 dependent immune disease, such as SLE, fare worse during pregnancy.

Interestingly, three autoimmune diseases, rheumatoid arthritis, multiple sclerosis and thyroiditis, that are reported to ameliorate or stabilize during pregnancy in the majority of women, are more likely to relapse during the year after delivery. The postpartum period can be regarded as a time of ongoing heightened inflammatory activity. The onset of rheumatoid arthritis is five times more likely in the puerperal period than at any other time. Multiple sclerosis is known to ameliorate during the last trimester of pregnancy. After delivery, the relapse rate is higher than that before pregnancy. Importantly, the decrease in the relapse rate during pregnancy was more marked than any drug mediated therapeutic effect reported to date. Of the acute endocrine emergencies an acute form of Sheehan’s may go unrecognized, leading to unnecessary maternal deaths. Cushing’s syndrome has very bad consequences for the fetus and must be diagnosed and treated urgently, if not emergently. Pheochromocytomas are always endocrine emergencies requiring urgent and sometimes emergent treatment. Hyperparathyroidism is usually mild, but severe hypercalcemia can be a true endocrine emergency.

Recognition of the interactions of these endocrine conditions and their specific treatments with the complicated maternal-fetal unit makes their diagnosis and treatment simultaneously both difficult and extremely rewarding.