Contents
In pregnant women there is a state of physiological hypercortisolemia – the concentration of cortisol in the blood increases about 2-3 times. The concentration of aldosterone in the blood increases significantly, even several times, especially at the end of pregnancy. Plasma renin activity is also increased.
Diseases of the adrenal glands and primary adrenal insufficiency (Addison’s disease)
As in the general population, the autoimmune process is the main cause of adrenal insufficiency during pregnancy. Timely diagnosis of Addison’s disease is very important because if it is left untreated during pregnancy, there is a high risk of adrenal crisis and a high death rate.
symptoms
The following symptoms may be suspected of Addison’s disease:
- significant weakness,
- nausea,
- vomiting,
- weight loss
- lack of appetite
- dark discoloration of the integuments (the whole body as opposed to unregulated discoloration occurring during physiological pregnancy).
These symptoms can appear in any pregnancy, so it is not always possible to diagnose Addison’s disease on the basis of clinical symptoms. Abnormal electrolyte levels in the blood, that is, high potassium levels and, to a lesser extent, low sodium levels, may raise the suspicion of adrenal insufficiency.
Diagnostics
Interpretation of the results of hormone tests on the hypothalamic-pituitary-adrenal axis during pregnancy is difficult. The concentration of cortisol may be within the normal range, typical for the pre-pregnancy period. Based on the outcome, determining the final diagnosis may be facilitated a boost test with a synthetic ACTH preparation. The lack of elevation of cortisol levels as a result of intravenous injection of synthetic ACTH preparation indicates primary or secondary adrenal insufficiency.
Differentiation
The differentiation of primary and secondary adrenal insufficiency in pregnant women is additionally difficult. While in other patients with secondary adrenal insufficiency, low cortisol levels are accompanied by low ACTH levels under baseline conditions, blood levels of ACTH are not low in pregnant women with secondary adrenal insufficiency due to its additional placental origin. In such a case, a test with a higher dose of synthetic ACTH and an extension of the measurement time of cortisol levels to 24 hours may be helpful, as a result of which there is an increase in cortisol secretion in secondary, but not primary, adrenal insufficiency.
In Addison’s disease, elevated levels of antibodies to the adrenal glands are characteristic.
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Diseases of the adrenal glands and hyperfunction of the adrenal cortex
The diagnosis of Cushing’s syndrome is described above. Primary aldosteronism (Conn’s syndrome) is rarely diagnosed during pregnancy. Its most common cause is adrenal adenoma. Conn’s syndrome should be suspected in patients with hypertension and hypokalaemia, although hypokalaemia is not always observed in pregnancy due to the anti-caleuretic effect of progesterone.
The diagnosis is made on the basis of low plasma renin activity. The concentration of aldosterone in pregnant patients with Conn’s syndrome is elevated, but to a similar extent as in other healthy pregnant women. An imaging test helpful in confirming the diagnosis is an MRI of the adrenal glands.
Diseases of the adrenal glands – pheochromocytoma
Pheochromocytoma of the adrenal gland is rare in the general population, and even more so during pregnancy, it may be the cause of severe arterial hypertension in pregnant women.
symptoms
In addition to arterial hypertension, which may be continuous or paroxysmal, the symptoms of phaeochromocytoma may include:
- feeling anxious
- increased sweating,
- headaches,
- a feeling of heart palpitations.
These symptoms, if they existed before pregnancy, may worsen during pregnancy due to the increase in tumor vasculature and the action of mechanical factors (growing fetus and its movements).
Diagnosis of pheochromocytoma
As the metabolism of catecholamines does not change significantly in pregnancy, the diagnosis of pheochromocytoma and the interpretation of test results are the same as in other patients. Diagnostic methods include: determination of the concentration of catecholamines in the blood and the content of catecholamines and their metabolites in the XNUMX-hour urine collection, as well as MRI or possibly ultrasound examination of the abdominal cavity.
Differentiation
The differential diagnosis includes pregnancy-induced hypertension and pre-eclampsia. In the case of phaeochromocytoma, no symptoms typical of preeclampsia such as edema or proteinuria are found.
Source: A. Cajdler-Łuba, S. Mikosiński, A. Sobieszczańska-Jabłońska, I. Nadel, I. Salata, A. Lewiński: “FUNCTIONAL DIAGNOSTICS OF HORMONAL DISORDERS WITH ELEMENTS OF DIFFERENTIAL DIAGNOSTICS; Czelej Publishing House