Management von Hypophysen- und Nebennierenerkrankungen in der Schwangerschaft

Management of Pituitary and Adrenal Disorders in Pregnancy. Pregnancy in concomitant pituitary or adrenal disorders requires special medical attention and treatment since maternal and fetal morbidity and mortality may be increased. If previously known and adequately treated, pregnancy in Addison’s disease can take an inconspicuous course. However, it is associated with an increased rate of premature deliveries and Caesarean sections. Fetal cortisol secretion may attenuate maternal symptoms of a hitherto unknown Addison’s disease which may become apparent by a postpartum adrenal crisis. Hydrocortisone and fludrocortisone substitutions should be increased by 30–50 % in the third trimester although this is discussed controversially. Pregnancy in Cushing’s syndrome is rare and leads to considerably increased fetal mortality (~20 %) and maternal morbidity. Diagnostic investigation is hampered by the altered hypothalamic-pituitary-adrenal axis in pregnancy. For screening purposes, urinary free cortisol, midnight cortisol, and diurnal salivatory cortisol should be employed since circadian cortisol rhythm is maintained in a normal pregnancy. Surgery is the intended treatment of Cushing’s syndrome in pregnant women although in the third trimester, adrenostatic drugs (metyrapon) provide an alternative. Acromegaly in pregnancy is accompanied by an increased fetal and maternal morbidity. Maternal growth hormone and IGF-1 do not pass the placental barrier and do not seem to influence fetal growth. In most cases, growth hormone-suppressive therapy can be ceased in pregnancy. Somatostatin analogues and dopamine agonists cross the placenta, and the former may lead to reduced fetal growth. Pregnancy in prolactinomas may lead to tumor growth with visual field defects especially in macroadenomas. Dopaminagonistic medication should be ceased with notice of pregnancy except for selected cases with extrasellar tumor growth. Regular clinical and perimetrical controls are obligatory as in case of tumor growth dopaminergic medication will be continued. Present expert knowledge on bromocriptin and cabergoline given in pregnancy did not show any adverse events. J Klin Endokrinol Stoffw 2012; 5 (2): 7–11.