[Pregnancy and adrenal insufficiency. Apropos of a case and reminder of management procedures].
The authors report a case of pregnancy which proceeded normally in a patient who had Addison's disease. This is not a common condition for obstetricians to meet. Thanks to replacement hormone therapy a patient with Addison's disease can become fertile and pregnancy usually starts in a patient whose chronic adrenal insufficiency (Addison's disease) is known and has been treated. The consequences of this association are reviewed: In the first trimester of pregnancy the hormone state may become more disturbed because of intestinal troubles and can become acutely decompensated because of the "stress" of delivery and its immediate consequences. There are no maternal or fetal repercussions so long as hormone replacement is adequate. The delivery can be by the vaginal route unless there are obstetric contra-indications. These are the particular precautions that have to be undertaken, together with regular supervision of the mother to maintain her hormonal equilibrium: Looking for, prevention and treatment of any condition that may lead to adrenal decompensation: these are particularly intestinal upsets in the first trimester and urinary tract infections. At the end of pregnancy the patient should be hospitalised with resuscitation carried out during and after delivery. These may need to be performed in addition to any surgical procedure that is carried out. The infant does not have any particular treatment and can breast-feed.
Tschupp
M J
MJ
Service de Gynécologie-Obstétrique, Hôpital Sud, Rennes.
Laurent
M C
MC
Le Pors-Lemoine
P
P
Roze
J M
JM
Hespel
J P
JP
D000224:Addison Disease / Q000150:complications* / Q000628:therapy; D000328:Adult; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*
Grossesse et insuffisance surrénale. A propos d'une observation, rappel de la conduite à tenir.