ECE2019 Guided Posters Adrenal and Neuroendocrine - Clinical (13 abstracts)
Management and outcome of pregnancies in women with adrenal insufficiency: experience from a retrospective European study
Christina Bothou 1 , Gurpreet Anand 1 , Tina Kienitz 2 , Khyatisha Seejore 3 , Chiara Simeoli 4 , Emma G Ward 3 , Rosa Maria Paragliola 5 , Rosario Ferrigno 4 , Klaus Badenhoop 6 , Sophie Bensing 7 , Marianne Oksnes 2, , William Drake 9 , Jeanette Wahlberg 10 , Nicole Reisch 11 , Stefanie Hahner 12 , Simon Pearce 13 , Peter Trainer 14 , Gwendolin Etzrodt-Walter 15 , Sébastien P Thalmann 16 , Æse B Sævik 8 , Eystein Husebye 8 , Andrea M Isidori 17 , Henrik Falhammar 7 , Gesine Meyer 6 , Salvatore M Corsello 5 , Rosario Pivonello 4 , Robert Murray 3 , Marcus Quinkler 2 & Felix Beuschlein 1,
1Department for Endocrinology, Diabetology and Clinical Nutrition, UniversitätsSpital Zürich, Zurich, Switzerland; 2Endocrinology in Charlottenburg, Berlin, Germany; 3Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK; 4Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy; 5Unit of Endocrinology, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; 6Department of Internal Medicine I, Division of Endocrinology, Diabetes and Metabolism, University Hospital Frankfurt, Frankfurt am Main, Germany; 7Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden; 8Institute of Medicine, Haukeland University Hospital, Jonas Liesvei 65, N-5021, Bergen, Norway; 9Barts Heart Centre, William Harvey Research Institute, Barts and the London Medical School, Queen Mary University London, WCIM 6BQ,, London, UK; 10Department of Endocrinology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; 11Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany; 12Department of Internal Medicine I, Endocrinology and Diabetes Unit, University Hospital of Würzburg, University of Würzburg, Würzburg, Germany; 13Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK; 14The Christie NHS Foundation, MAHSC, Wilmslow Road, Manchester M20 4BX, Manchester, UK; 15Endokrinologiezentrum Ulm, Ulm, Germany; 16Ärztezentrum Sihlcity, Zurich, Switzerland; 17Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Background and aims: Recommendations for the management of pregnancies in patients with adrenal insufficiency (AI) are scarce. The aim of this study was to analyse current clinical approaches in seventeen specialized centers across Europe with a particular focus on maternal and fetal outcome.
Patients: 95 pregnancies in 86 patients with AI of different aetiology [Addison’s disease (n=37), secondary AI (n=22), congenital adrenal hyperplasia (CAH) (n=22), or other reasons of AI including bilateral adrenalectomy (n=5)] were followed since 2013. Clinical and biochemical parameters and treatment details were assessed before and during pregnancy and maternal and fetal outcomes were recalled.
Results: 66.3% (59/89) of the pregnancies were substituted with hydrocortisone in two or three daily doses while 14.6% (13/89) were treated with modified hydrocortisone, 9% with prednisolone, 5.6% with cortisone acetate and 6.7% with a combination of different steroids. The mean hydrocortisone equivalent dose before pregnancy was significantly lower in comparison to that during pregnancy (21.0±7.7mg/day before vs. 23.1±8.0 during 1st trimester, 25.5±10.6 during 2nd trimester und 25.9±8.3 during 3rd trimester) but did not differ significantly between trimesters. Fludrocortisone was used in 92.9% of the Addison’s cases and in 39.1% of women with CAH before pregnancy and dosage was increased in 51% (23/45) of patients. Overall, in 63.1% of all cases glucocorticoid or mineralocorticoid dosage was adapted at least once during pregnancy. For delivery, in 55.3% (47/85) of all pregnancies caesarian section was performed while only in 8/47 cases the reason was clearly documented or was conducted as an emergency procedure. Hydrocortisone administration during delivery varied among different centers with no clearly standardized practice followed. Considering the outcome, 24 of 86 women (27.9%) had a documented history of at least one previous abortion with further three miscarriages taking place during the first trimester within the observation interval. While no maternal or fetal deaths occurred later during pregnancies, in 7/95 pregnancies minor complications for maternal and in 3/95 for fetal outcome were reported.
Conclusion: Overall, these retrospective data indicate good maternal and fetal outcome of pregnancies in AI patients. However, optimized treatment adjustments during pregnancy and appropriate approaches during delivery remain challenging, considering the lack of evidence-based guidelines. A remaining proportion of reported adrenal crisis during pregnancy and histories of abortion highlight the need for appropriate education of patients and treating physicians as well as early diagnosis of adrenal insufficiency in general.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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