{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:13:56Z","timestamp":1792523636174,"version":"4.5.0"},"reference-count":33,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,3,12]],"date-time":"2013-03-12T00:00:00Z","timestamp":1363046400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2013,4]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>A new diagnosis of primary adrenal insufficiency (<jats:styled-content style=\"fixed-case\">PAI<\/jats:styled-content>) during pregnancy is extremely rare and difficult to recognize as signs and symptoms such as nausea, fatigue and hypotension may resemble features of normal pregnancy. However, if the diagnosis is overlooked and steroid replacement delayed, subsequent adrenal crisis triggered by hyperemesis gravidarum, fever or delivery can cause severe maternal and foetal morbidity and even mortality. In case of clinical suspicion of <jats:styled-content style=\"fixed-case\">PAI<\/jats:styled-content>, we recommend to measure paired samples of cortisol and <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> and, if clinically feasible, a short synacthen test. We propose trimester\u2010specific pass cut\u2010offs for the short synacthen test that take into account the rise of total and also free cortisol during pregnancy. Empirical hydrocortisone treatment should never be delayed if the clinical suspicion is high. All pregnant women with <jats:styled-content style=\"fixed-case\">PAI<\/jats:styled-content> should be monitored by a team of endocrine and obstetric specialists. The third trimester is physiologically associated with a rise not only in total but also free cortisol and thus requires regular adjustment of the glucocorticoid dose. Mineralocorticoid requirements may change during pregnancy due to the anti\u2010mineralocorticoid properties of progesterone. As plasma renin physiologically increases in pregnancy, monitoring is limited to clinical assessment including blood pressure and serum electrolytes. It is crucial that a pregnant woman with <jats:styled-content style=\"fixed-case\">PAI<\/jats:styled-content> and her partner are well educated regarding the adjustment of glucocorticoid dose in intercurrent illness and that both are trained in hydrocortisone emergency injection techniques. The obstetric staff should be provided with clear and written guidance for hydrocortisone cover during labour and delivery. With the appropriate replacement therapy, <jats:styled-content style=\"fixed-case\">PAI<\/jats:styled-content> patients can expect to have an uneventful pregnancy and deliver a healthy infant.<\/jats:p>","DOI":"10.1111\/cen.12097","type":"journal-article","created":{"date-parts":[[2012,11,15]],"date-time":"2012-11-15T23:36:36Z","timestamp":1353022596000},"page":"497-502","source":"Crossref","is-referenced-by-count":74,"title":["What is the best diagnostic and therapeutic management strategy for an Addison patient during pregnancy?"],"prefix":"10.1111","volume":"78","author":[{"given":"Marie","family":"Lebbe","sequence":"first","affiliation":[{"name":"Centre for Endocrinology Diabetes and Metabolism School of Clinical &amp; Experimental Medicine University of Birmingham Birmingham United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiebke","family":"Arlt","sequence":"additional","affiliation":[{"name":"Centre for Endocrinology Diabetes and Metabolism School of Clinical &amp; 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