Adrenal Insufficiency In Pregnancy


Diagnosis

Pathophysiology

Treatment

  1. Women on steroids with suspected suppression of the adrenal gland need stress doses of steroids during delivery or periods of serious illness
  2. Hydrocortisone 100mg IV/IM every 8 hours at onset of labor with taper to 50 mg every 8 hours on post delivery day 1 and 2
  3. Suspect pituitary necrosis if adrenal insufficiency immediately postpartum
  4. Draw blood for cortisol, ACTH. Draw thyroxine (T4), triiodothyronine (T3), prolactin, and growth hormone if pituitary necrosis suspected
  5. Replace volume loss with isotonic fluids
  6. Add dextrose to fluids to prevent hypoglycemia
  7. Give 100 mg Hydrocortisone as IV bolus and additional 100 mg every 8 hours
  8. Normal maintenance steroid dosing for adrenal insufficiency
  9. All are class C and safe in pregnancy with neonatal adrenal suppression very uncommon from either crossing placenta or in breast milk 

Disposition

  1. Admit all pts w/ suspected adrenal insufficiency or who are unable to hold down their oral maintenance steroids
  2. Pregnant women on steroids presenting with minor illnesses may be discharged