{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:16:58Z","timestamp":1784557018455,"version":"3.55.0"},"reference-count":14,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2018,4,12]],"date-time":"2018-04-12T00:00:00Z","timestamp":1523491200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/deed.en_GB"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,4,12]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Addison\u2019s disease, or primary adrenocortical insufficiency, is a long-term, potentially severe, rare endocrine disorder. In pregnancy, it is even rarer. We report the case of a 30-year-old pregnant patient with Addison\u2019s disease, referred to Obstetrics-Endocrinology specialty consult at 14 weeks gestation. She had been to the emergency department of her local hospital various times during the first trimester presenting with a clinical scenario suggestive of glucocorticoid under-replacement (nausea, persistent vomiting and hypotension), but this was interpreted as normal pregnancy symptoms. Hydrocortisone dose was adjusted, and the patient maintained regular follow-up. No complications were reported for the remainder of gestation and delivery. Pregnant patients with Addison\u2019s disease should be monitored during gestation and in the peripartum period by multidisciplinary teams. Adjustments in glucocorticoid and mineralocorticoid replacement therapy are often necessary, and monitoring should be based mainly on clinical findings, which becomes increasingly difficult during pregnancy. Patient education and specialized monitoring are key to avoiding complications from under- or over-replacement therapy in this period.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points:<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>An increase in glucocorticoid replacement dose is expected to be necessary during pregnancy in a woman with Addison\u2019s disease.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Patient education regarding steroid cover and symptoms of acute adrenal crisis are fundamental.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Monitoring in this period is challenging and remains mainly clinical.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>The increase in hydrocortisone dose often obviates the need to increase fludrocortisone dose.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-17-0179","type":"journal-article","created":{"date-parts":[[2018,4,12]],"date-time":"2018-04-12T11:01:46Z","timestamp":1523530906000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":6,"title":["Treatment of Addison\u2019s disease during pregnancy"],"prefix":"10.1530","volume":"2018","author":[{"given":"Diana","family":"Oliveira","sequence":"first","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Center, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Lages","sequence":"additional","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Center, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Paiva","sequence":"additional","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Center, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Carrilho","sequence":"additional","affiliation":[{"name":"Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Center, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref41","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1210\/jc.2015-1710","article-title":"Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline","volume":"101","year":"2016","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref31","first-page":"45","article-title":"AnandGBeuschleinF of endocrine disease fertility pregnancy and lactation in women with adrenal insufficiency of https org","journal-title":"Management European Journal Endocrinology"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.beem.2014.08.008","article-title":"Mineralocorticoid substitution and monitoring in primary adrenal insufficiency","volume":"29","year":"2015","journal-title":"Best Practice and Research: Clinical Endocrinology and Metabolism"},{"key":"ref91","doi-asserted-by":"crossref","first-page":"5249","DOI":"10.1210\/jc.2010-0108","article-title":"Addison\u2019s disease in women is a risk factor for an adverse pregnancy outcome","volume":"95","year":"2010","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref111","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1210\/jc.2015-1710","article-title":"Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline","volume":"101","year":"2016","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref121","first-page":"497","article-title":"What is the best diagnostic and therapeutic management strategy for an addison patient during pregnancy?","volume-title":"Clinical Endocrinology","volume":"78","year":"2013"},{"key":"ref131","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.beem.2014.08.008","article-title":"Mineralocorticoid substitution and monitoring in primary adrenal insufficiency","volume":"29","year":"2015","journal-title":"Best Practice and Research: Clinical Endocrinology and Metabolism"},{"key":"ref51","first-page":"497","article-title":"What is the best diagnostic and therapeutic management strategy for an addison patient during pregnancy?","volume-title":"Clinical Endocrinology","volume":"78","year":"2013"},{"key":"ref81","doi-asserted-by":"crossref","first-page":"4354","DOI":"10.1210\/jc.2010-0445","article-title":"Sexuality and fertility in women with addison\u2019s disease","volume":"95","year":"2010","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"4354","DOI":"10.1210\/jc.2010-0445","article-title":"Sexuality and fertility in women with addison\u2019s disease","volume":"95","year":"2010","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"5249","DOI":"10.1210\/jc.2010-0108","article-title":"Addison\u2019s disease in women is a risk factor for an adverse pregnancy outcome","volume":"95","year":"2010","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref101","first-page":"45","article-title":"AnandGBeuschleinF of endocrine disease fertility pregnancy and lactation in women with adrenal insufficiency of https org","journal-title":"Management European Journal Endocrinology"},{"key":"ref01","volume-title":"William\u2019s Endocrinology"},{"key":"ref71","volume-title":"William\u2019s Endocrinology"}],"container-title":["Endocrinology, Diabetes &amp; Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2018\/1\/EDM17-0179.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2018\/1\/EDM17-0179.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:46:48Z","timestamp":1784555208000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,12]]},"references-count":14,"URL":"https:\/\/doi.org\/10.1530\/edm-17-0179","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4,12]]}}}