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Endocrine disease in pregnancy 

Endocrine disease in pregnancy

Chapter:
Endocrine disease in pregnancy
Author(s):

John H. Lazarus

DOI:
10.1093/med/9780199204854.003.1411
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date: 27 March 2017

Endocrine function in the developing fetus is initially almost entirely dependent on the mother, with the fetus becoming less reliant on maternal hormones as the fetal glands develop and mature from the second trimester onwards.

Endocrine diseases particular to pregnancy

Lymphocytic hypophysitis—typically presents with symptoms of an expanding pituitary tumour; increasingly recognized as a cause of hypopituitarism occurring late in pregnancy and in the postpartum period.

Sheehan’s syndrome (postpartum hypopituitarism)—caused by pituitary infarction following significant hypotension occurring at the time of delivery.

Postpartum thyroiditis—characterized by transient hyperthyroidism followed by hypothyroidism; occurs in 50% of anti-thyroid peroxidase (anti-TPO) positive women and only rarely in antibody negative women.

Pregnancy in women with endocrine disorders

Hyperprolactinaemia—this must be corrected to allow ovulation and fertility. Prolactinomas may enlarge during pregnancy and cause visual impairment: the risk is 2% for a microprolactinoma and >15% for a macroprolactinoma.

Acromegaly—fertility is impaired in women with acromegaly, and management of pregnancy is difficult because there is a risk that the responsible pituitary adenoma may enlarge and cause visual impairment. Very close monitoring by testing of visual fields and pituitary MRI scanning is required.

Cushing’s syndrome—difficult to diagnose in pregnancy, and there is a high risk of maternal and fetal complications.

Hyperthyroidism—occurs in 0.2% of pregnancies, usually due to Graves’ disease, and is best diagnosed on the basis of an elevated serum free tri-iodothyronine (T3) in association with a suppressed TSH. The baby is at risk of hyperthyroidism due to the transplacental passage of thyroid stimulating antibodies. Treatment can be by antithyroid drugs or surgery, but not by radio-iodine.

Hypothyroidism—associated with a number of complications in pregnancy, including fetal neurological problems ranging from cretinism to impaired child development. Pregnant patients with hypothyroidism should always be treated with thyroxine, with increased dose requirements during gestation.

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