Dr Prue Hogg1,2, Dr Fiona Britten1,3, Dr Penny Wolski1,3
1Royal Brisbane And Women's Hospital, Brisbane, Australia, 2Mater Hospital, Brisbane, Australia, 3Senior Lecturer Greater Brisbane Clinical School, University of QLD, Brisbane, Australia
Biography:
Prue is a General Physician and completed her Obstetric Medicine training in both Cairns and Brisbane. She undertook a fellowship of Obstetric Medicine at the Royal Brisbane and Women’s Hospital in 2023, where she is currently working as an Obstetric Physician.
Abstract:
Primary adrenal insufficiency is a rare disease that disproportionally affects women of childbearing age (Chabre et al 2017). It characterised by insufficient production of glucocorticoids and mineralocorticoids from the adrenal glands and is treated by administration of deficient hormones. Complications from the illness and its treatment are associated with adverse maternofoetal outcomes (Bothou et al 2020; Schneiderman et al 2016), and pregnancy offers multiple challenges for affected women and clinicians. Adrenal crisis is a life-threatening complication of adrenal insufficiency characterised by cardiovascular collapse. Although uncommon in pregnancy, the risk of maternal and foetal morbidity and mortality is high, and symptoms have some overlap with that of normal pregnancy, making the diagnosis challenging. Moreover, changes in requirement and metabolism of exogenous corticosteroids across pregnancy, and the risks associated with over replacement, require careful monitoring with no biomarkers to guide dosing. Published research regarding the treatment and outcomes of primary adrenal insufficiency during pregnancy limited and largely to case studies (Gardella et al 2022; Oliveira et al 2018), and as such, management of these women is based on expert opinion, with no formal guidelines.
This study is a case series exploring the clinical expression, management and maternofoetal outcomes of women who had a diagnosis of primary adrenal insufficiency and received antenatal care at the Royal Brisbane and Women’s Hospital from January 1st 2013– December 31st 2023.
This study adds to the current literature by outlining the typical course, complications (both from the illness itself and its treatment), challenges, and treatment of these women during pregnancy in an Australian tertiary centre. The study aims to expand the knowledge of that management of primary adrenal insufficiency during pregnancy to improve the outcomes for pregnant women and their babies.
The study is currently underway; we anticipate having 10 cases included in the study.
Keywords
Adrenal insufficiency, pregnancy, Addison’s, adrenal crisis.
References
Bothou C, Anand G, Li D, Kienitz T, Seejore K, Simeoli C, Ebbehoj A, Ward EG, Paragliola RM, Ferrigno R, Badenhoop K. Current management and outcome of pregnancies in women with adrenal insufficiency: experience from a multicenter survey. The Journal of Clinical Endocrinology & Metabolism. 2020 Aug;105(8):e2853-63.
Gardella B, Gritti A, Scatigno AL, Gallotti AM, Perotti F, Dominoni M. Adrenal crisis during pregnancy: case report and obstetric perspective. Frontiers in Medicine. 2022 Sep 14;9:891101.
Schneiderman M, Czuzoj‐Shulman N, Spence AR, Abenhaim HA. Maternal and neonatal outcomes of pregnancies in women with Addison's disease: a population‐based cohort study on 7.7 million births. BJOG: An International Journal of Obstetrics & Gynaecology. 2017 Oct;124(11):1772-9.