Update on adrenal insufficiency: Diagnosis and management in pregnancy

Fabienne Langlois, Dawn S.T. Lim, Maria Fleseriu

Research output: Contribution to journalReview articlepeer-review

30 Scopus citations


Purpose of review Adrenal insufficiency in pregnancy, although relatively rare, has significant clinical implications on both maternal and fetal outcomes. Hypothalamo-pituitary-adrenal axis dynamics and physiological changes are complex, thus diagnosis and management of adrenal insufficiency in pregnancy remain challenging. Recent findings Studies consistently demonstrate a rise in total serum cortisol with pregnancy, but less data are available on free cortisol levels. Salivary cortisol values have been measured in normal pregnancy and in a few studies using healthy nonpregnant women controls. Although this adds to our current knowledge of hypothalamo-pituitary-adrenal axis changes in pregnancy, clear-cut cortisol reference ranges are yet to be established. Serum cortisol and the cosyntropin stimulation test (albeit with higher peak cortisol thresholds) are currently the diagnostic tests of choice. Hydrocortisone is the preferred glucocorticoid replacement in pregnancy as it is inactivated by placental 11-β-hydroxysteroid dehydrogenase 2; dose titration may be required, but should be individualized depending on clinical course and mode of delivery. Summary Further studies on the long-term effects of maternal glucocorticoid regimens on the fetus and potential modulators of fetal glucocorticoid sensitivity and placental 11-β-hydroxysteroid dehydrogenase 2 are needed and will be useful in guiding clinical management strategies in pregnant women with adrenal insufficiency.

Original languageEnglish (US)
Pages (from-to)184-192
Number of pages9
JournalCurrent Opinion in Endocrinology, Diabetes and Obesity
Issue number3
StatePublished - Jun 1 2017


  • adrenal insufficiency
  • hypoadrenalism
  • pregnancy
  • primary adrenal insufficiency
  • secondary adrenal insufficiency

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Nutrition and Dietetics


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