title: Fetal adrenal suppression due to maternal corticosteroid use: case report.
abstract: During pregnancy, steroids are usually used in maternal diseases such as adrenal failure or other autoimmune diseases, e.g. idiopathic thrombocytopenic purpura (ITP), Crohn's disease, systemic lupus erythematosus, dermatomyositis, scleroderma, Addison's disease and hyperemesis gravidarum, HELLP syndrome. Endogenous or exogenousmaternal steroids are metabolized by the placental enzyme 11 beta-hydroxy steroid dehydrogenase type 2. Prednisolone and methylprednisolone are highly sensitive to this enzyme, while dexamethasone and betamethasone are less well metabolized. Steroids which can cross the placental barrier are administered in cases like fetal lupus, congenital adrenal hyperplasia and for enhancement of fetal lung maturation, whereas steroids used in maternal diseases are usually the ones with low affinity to the placenta; however, in case of long-term use or in high doses, placental enzyme saturation occurs and thus, resulting in fetal adrenal suppression. Antenatal steroids can lead to low birth weight, as observed in our patient. Here, we report a case with fetal adrenal suppression due to maternal methylprednisolone use presenting with early hypoglycaemia and late hyponatremia in neonatal period and requiring three-month replacement therapy.
authors.affiliation: Erciyes University Faculty of Medicine, Department of Pediatrics Division of Neonatology, Kayseri, Turkey.
authors.forename: Selim
authors.initials: S
authors.lastname: Kurtoğlu
authors.forename: Dilek
authors.initials: D
authors.lastname: Sarıcı
authors.forename: Mustafa Ali
authors.initials: MA
authors.lastname: Akın
authors.forename: Ghaniya
authors.initials: G
authors.lastname: Daar
authors.forename: Levent
authors.initials: L
authors.lastname: Korkmaz
authors.forename: Şeyma
authors.initials: Ş
authors.lastname: Memur
mesh_terms: D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000628:therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy
chemical_list: D008775:Methylprednisolone