Endocrine Abstracts

JOINT3768

Introduction: Pregnancy presents unique challenges for women. When complicated by or associated with adrenal insufficiency, diagnosis and management become particularly challenging due to the overlap between the condition’s symptoms and the physiological changes of pregnancy.

Object: To assess the etiologies, management, and outcomes of pregnancy in women with adrenal insufficiency

Methods: We conducted a retrospective descriptive study of patients with adrenal insufficiency who were hospitalized or seen in our endocrinology department between 2019 and 2024.

Results: Our study included 15 pregnant women with adrenal insufficiency (AI). Five patients had glucocorticoid-induced AI. In one case, AI onset occurred during the first trimester of pregnancy. This patient presented with an adrenal crisis initially misdiagnosed as hyperemesis gravidarum due to nausea and vomiting, resulting in a 48-h diagnostic delay. Four patients had AI secondary to pituitary dysfunction: two with Cushing’s disease, one with prolactinoma, and one with acromegaly. All patients with pituitary-related AI had the condition prior to pregnancy and received close monitoring throughout gestation. None of them experienced an aggravation of their condition during pregnancy. Six patients had primary AI. Two diagnoses occurred during the third trimester of pregnancy, indicating the onset of AI during gestation in these cases. One patient experienced a prolonged diagnostic delay as hypoglycemia was initially attributed to renal failure. Another patient with Nelson syndrome had a spontaneous pregnancy. The remaining patients with primary AI had autoimmune Addison’s disease with concomitant type 1 diabetes prior to pregnancy. All patients received close monitoring and hydrocortisone replacement therapy with dose adjustments during the third trimester (+20-30%). Mineralocorticoid supplementation was not used in patients with primary AI. Adrenal crises occurred in five cases, all triggered by infections. The frequency of crises was higher in the glucocorticoid-induced AI and Addison’s disease groups compared to the pituitary-related AI group. All patients underwent medically assisted delivery in a tertiary care setting with intravenous hydrocortisone administration. Adverse outcomes were observed in five cases, including 1 case of intra-uterine fetal demise, 2 cases of acute fetal distress, 1 case of macrosomia, and one case of post term pregnancy.

Conclusion: Our findings underscore the diagnostic challenges of adrenal insufficiency during pregnancy, particularly the risk of delayed diagnosis and the potential for new-onset disease. These findings emphasize the need for heightened clinical vigilance and a multidisciplinary approach to care.