Endocrine Abstracts

Background: Primary adrenal insufficiency or Addison’s disease (AD) is characterized by glucocorticoid and mineralocorticoid deficiency due to lesion of the adrenal glands through different mechanisms (1). Addison’s disease is a risk factor for adverse maternal and neonatal outcomes. Close monitoring is required for these patients during the intrapartum and postpartum periods.(2)

Objective: Retrospective evaluation of the management of Addison’s disease in pregnant patients, focusing on adherence to guidelines, monitoring practices, and maternal and fetal outcomes.

Methods: Retrospective data was collected after reviewing medical records of pregnant patients with diagnosed Addison’s disease.

Results: n=7, mean age of 27, mean BMI at booking 30.5, 100% patients were on Hydrocortisone and Fludrocortisone, All pregnancies were spontaneous, 15% patient had hospital admission with adrenal crisis within one year prior to the pregnancy, 2 patients had miscarriage (at 6th week and 8th week) and both of them prior to first antenatal visit, 70% patient had successful outcome of pregnancy and among them all were reviewed in endocrine antenatal or maternal medicine clinic. None of the patient was reported to have gestational hypertension or pre-eclampsia. Mean Sodium was 137 (lowest 128 and highest 142), Potassium was 4.8 (lowest 4.2 and highest 5.6). Among the 70% pregnancy, all of them reached the term and all had NVD. Labour was induced in 1 patient. Average birthweight of the babies was 2900 grams (highest 3500 gram and lowest 2300 grams). Neonatal seizure or neonatal hypoglycaemia was reported in none of the babies.

Conclusion: This audit highlights the importance of stringent adherence to management protocols for Addison’s disease during pregnancy. Pregnant individuals with Addison’s disease require ongoing monitoring throughout pregnancy and postpartum by multidisciplinary teams. It is crucial to provide patient education and specialized monitoring to prevent complications arising from inadequate or excessive replacement therapy during this time. Timely referral to hospital services facilitating collaboration between Endocrinology and Obstetrics is essential.