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Review
. 2024 Jan 12;13(2):e230088.
doi: 10.1530/EC-23-0088. Print 2024 Feb 1.

Fertility and pregnancy in adrenal insufficiency

Deirdre Green  1 , Rosemary Dineen  1 , Michael W O'Reilly  1 , Mark Sherlock  1
Affiliations
Review

Fertility and pregnancy in adrenal insufficiency

Deirdre Green et al. Endocr Connect. .

Abstract

Despite the availability of adrenal hormone replacement therapy, patients with adrenal insufficiency can be affected by reduced fertility and parity. Patients with well-managed adrenal insufficiency are expected to have uneventful pregnancies and favourable outcomes, but an increased risk of maternal and neonatal complications has been reported in some cases. Many physiological changes occur to the hypothalamic-pituitary-adrenal (HPA) axis during pregnancy, often making a new diagnosis and management of adrenal insufficiency challenging. The management of adrenal insufficiency also needs to reflect the physiologic changes of pregnancy, often requiring increased doses of glucocorticoid as pregnancy progresses and in some circumstances mineralocorticoid replacement (in primary adrenal insufficiency patients only), especially in the third trimester. To date, there are no prospective data guiding management of adrenal insufficiency in pregnancy. In this review, we focus on the impact of adrenal insufficiency on fertility and parity based on the aetiology of adrenal insufficiency and provide a practical approach to the management of patients with adrenal insufficiency before and during pregnancy.

Keywords: adrenal insufficiency; androgens; cortisol; fertility; pregnancy.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of this review.

Figures

Figure 1
Figure 1
Schematic representation of the maternal–placental–fetal steroidogenic unit. In the maternal compartment, increases in placental CRH promote increased synthesis and release of ACTH and cortisol. Maternal cortisol in turn stimulates placental CRH production, generating a positive feedback loop. Placental CRH stimulates production of fetal cortisol, both by increasing fetal adrenal responsiveness to ACTH and by direct stimulation of the adrenal. Increased fetal cortisol would in turn stimulate placental CRH production, constituting a second positive feedback loop. ACTH, adrenocorticotrophic hormone; CRH, corticotrophin-releasing hormone. Figure produced using biorender.com.
See this image and copyright information in PMC

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