Endocrine Abstracts

We report a case of a 25 years old woman – with central transient hypoadrenalism after the right adrenalectomy for Cushing syndrome. She became pregnant 1 year after surgery while still taking a small dose of cortisol replacement therapy (5 mg Hydrocortisone) for partial recovery of her corticotrophic axis. Her pregnancy has been complicated by gestational diabetes, with good metabolic control under small doses of basal insulin. She increased her substitutive therapy at 26 weeks of gestation by 50% to 7.5 mg of hydrocortisone. At week 32 of pregnancy, she experienced adrenal crisis due to an upper respiratory tract infection that was managed with parenteral cortisone. Subsequently, the dose was tapered to a maintenance dose of 30 mg hydrocortisone. Further attempts to lower the maintenance dose led to the recurrence of symptoms of hypoadrenalism. Elective cesarean delivery was performed uneventfully with parenteral hydrocortisone at a stress dose maintained for 48 h postpartum. A viable macrosom, otherwise healthy fetus was born (4270 g). Treatment with glucocorticoids during pregnancy should take into account that adrenal reserve increases as pregnancy progresses. Patients on glucocorticoid replacement may need to increase their hydrocortisone dose by 50% in the last trimester of pregnancy, and by the start of the labour, the hydrocortisone dose should be increased to stress doses for 48 h postpartum. Hydrocortisone crosses the placenta in small amounts because is metabolised into the placenta by 11-beta-hydroxylase steroid dehydrogenase-2 and should be the preferred steroid during pregnancy to prevent adrenal suppression of the fetus.