Pregnancies associated with primary adrenal insufficiency.
OBJECTIVE
To provide a framework for the clinical presentation, evolution, treatment, and outcome of the unusual association between primary adrenal insufficiency (AI) during pregnancy and life-threatening complications for the mother and fetus.


METHODS
Case reports.


METHODS
Pregnant women with AI treated in the Endocrine and Diabetes Department, Hospital Universitario de Maternidad y Neonatología, Córdoba, Argentina.


METHODS
Three pregnant women with AI.


METHODS
Review of hospital records.


METHODS
Clinical, laboratory features, treatment, and outcome.


RESULTS
Two women with AI were diagnosed before conception, and one was diagnosed during gestation. Two of the cases were associated with other autoimmune diseases. Two newborns were born with signs of fetal distress, and one passed away hours later. Poor outcome was related to low compliance with treatment.


CONCLUSIONS
AI is often overlooked during pregnancy because of its rarity and pregnancy-like symptoms. Nevertheless, other autoimmune diseases, hyponatremia, metabolic acidosis, nausea and vomiting, and orthostatic hypotension that does not improve with usual treatment or persists after first trimester should evoke a diagnosis of AI. If diagnosis and treatment are properly managed, pregnancy, labor, and delivery may occur without complications. If not, AI is associated with high maternal and fetal morbidity and mortality.
Fux Otta
Carolina
C
Departamento de Endocrinología y Diabetes, Hospital Universitario de Maternidad y Neonatología de Córdoba, Córdoba Capital, Argentina. endofux@yahoo.com.ar
Szafryk de Mereshian
Paula
P
Iraci
Gabriel Santino
GS
Ojeda de Pruneda
María Rosa
MR
D000224:Addison Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D000328:Adult; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy*