Primary adrenocortical insuiciency is rare because more than 90 percent of total gland volume must be destroyed for symptoms to develop. Autoimmune adrenalitis is the most common cause in the developed world, but tuberculosis is a more frequent etiology in resource-poor countries (Arit, 2015; Kamoun, 2014). The incidence has been cited as being as high as 1 in 3000 births in Norway (Lekarev, 2011). In the United States, the prevalence was 1 per 10,000 to 20,000 pregnancies (Schneiderman, 2017). here is an increased incidence of concurrent Hashimoto thyroiditis, primary ovarian insuiciency, type 1 diabetes, and Graves disease. These poyglandular autoimmune syndromes also include pernicious anemia, vitiligo, alopecia, nontropical sprue, and myasthenia gravis.
Untreated adrenal hypofunction frequently causes infertility, but with replacement therapy, ovulation is restored. If untreated, symptoms often include weakness, fatigue, nausea and vomiting, and weight loss. Because serum cortisol levels are increased during pregnancy, the inding of a low value should prompt a cosyntropin test to document the lack of response to infused corticotropin (Salvatori, 2005).
In a large Swedish cohort study, 1188 women with Addison disease were compared with more than 11,000 age-matched controls who delivered between 1973 and 2006 (Bjornsdottir, 2010). Women diagnosed with adrenal insuiciency within 3 years of delivery were signiicantly more likely to deliver preterm, to deliver a low-birthweight newborn, and to undergo cesarean delivery. Others have reported similar adverse outcomes (Quartermaine, 2017). Most pregnant women with Addison disease are already taking glucocorticoid and mineralocorticoid replacement drugs. hese should be continued and women observed for evidence of either inadequate or excessive corticosteroid replacement (Lebbe, 2013). During labor, delivery,r and postpartum, or after a surgical procedure, corticosteroid replacement must be increased appreciably to approximate the normal adrenal response-the so-called stress dose. Hydrocortisone, 100 mg, is usually given intravenously every 8 hours for 48 hours. It is important that shock from causes other than adrenocortical insuiciency-for example, hemorrhage or sepsis-be recognized and treated promptly.
Hyperaldosteronism is caused by an adrenal adenoma-Conn syndrome-in approximately 75 percent of cases. Idiopathic bilateral adrenal hyperplasia makes up the remainder, except for rare cases of adrenal carcinoma (Abdelmannan, 2011; Eschler, 2015). Findings include hypertension, hypokalemia, and muscle weakness. High serum or urine levels of aldosterone confirm the diagnosis.