{"doi":"10.1210/clinem/dgaa266","title":"Current Management and Outcome of Pregnancies in Women With Adrenal Insufficiency: Experience from a Multicenter Survey","abstract":"CONTEXT: Appropriate management of adrenal insufficiency (AI) in pregnancy can be challenging due to the rarity of the disease and lack of evidence-based recommendations to guide glucocorticoid and mineralocorticoid dosage adjustment. OBJECTIVE: Multicenter survey on current clinical approaches in managing AI during pregnancy. DESIGN: Retrospective anonymized data collection from 19 international centers from 2013 to 2019. SETTING AND PATIENTS: 128 pregnancies in 113 women with different causes of AI: Addison disease (44%), secondary AI (25%), congenital adrenal hyperplasia (25%), and acquired AI due to bilateral adrenalectomy (6%). RESULTS: Hydrocortisone (HC) was the most commonly used glucocorticoid in 83% (97/117) of pregnancies. Glucocorticoid dosage was increased at any time during pregnancy in 73/128 (57%) of cases. In these cases, the difference in the daily dose of HC equivalent between baseline and the third trimester was 8.6 ± 5.4 (range 1-30) mg. Fludrocortisone dosage was increased in fewer cases (7/54 during the first trimester, 9/64 during the second trimester, and 9/62 cases during the third trimester). Overall, an adrenal crisis was reported in 9/128 (7%) pregnancies. Cesarean section was the most frequent mode of delivery at 58% (69/118). Fetal complications were reported in 3/120 (3%) and minor maternal complications in 15/120 (13%) pregnancies without fatal outcomes. CONCLUSIONS: This survey confirms good maternal and fetal outcome in women with AI managed in specialized endocrine centers. An emphasis on careful endocrine follow-up and repeated patient education is likely to have reduced the risk of adrenal crisis and resulted in positive outcomes.","journal":"The Journal of Clinical Endocrinology & Metabolism","year":2020,"id":91769,"datarank":1.5966265278208747,"base_score":3.8066624897703196,"endowment":3.8066624897703196,"self_citation_contribution":0.5709993734655481,"citation_network_contribution":1.0256271543553266,"self_endowment_contribution":0.5709993734655481,"citer_contribution":1.0256271543553266,"corpus_percentile":87.00394523091204,"corpus_rank":1681,"citation_count":44,"citer_count":31,"citers_with_citation_signal":24,"citers_with_endowment":24,"datacite_reuse_total":0,"is_dataset":true,"is_dataset_confidence":0.5434,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":459334,"name":"Gurpreet Anand","orcid":"0000-0002-3482-5065","position":1,"is_corresponding":false},{"id":337140,"name":"Dingfeng Li","orcid":"0000-0001-5795-0419","position":2,"is_corresponding":false},{"id":239594,"name":"Tina Kienitz","orcid":"0000-0003-4637-0405","position":3,"is_corresponding":false},{"id":459335,"name":"Khyatisha Seejore","orcid":"0000-0003-1633-4155","position":4,"is_corresponding":false},{"id":459336,"name":"Chiara Simeoli","orcid":"0000-0003-4275-337X","position":5,"is_corresponding":false},{"id":311948,"name":"Andreas Ebbehøj","orcid":"0000-0001-7104-7824","position":6,"is_corresponding":false},{"id":460352,"name":"Emma Ward","orcid":null,"position":7,"is_corresponding":false},{"id":459337,"name":"Rosa Maria Paragliola","orcid":"0000-0002-5070-7771","position":8,"is_corresponding":false},{"id":459338,"name":"Rosario Ferrigno","orcid":"0000-0002-8172-2405","position":9,"is_corresponding":false},{"id":460353,"name":"Klaus Badenhoop","orcid":null,"position":10,"is_corresponding":false},{"id":459339,"name":"Sophie Bensing","orcid":"0000-0002-9193-2860","position":11,"is_corresponding":false},{"id":459340,"name":"Marianne Øksnes","orcid":"0000-0002-9824-2088","position":12,"is_corresponding":false},{"id":459341,"name":"Daniela Espósito","orcid":"0000-0001-8993-2071","position":13,"is_corresponding":false},{"id":459342,"name":"Ragnhildur Bergthorsdottir","orcid":"0000-0002-9535-8632","position":14,"is_corresponding":false},{"id":460354,"name":"William Drake","orcid":null,"position":15,"is_corresponding":false},{"id":459343,"name":"Jeanette Wahlberg","orcid":"0000-0003-4061-6830","position":16,"is_corresponding":false},{"id":459344,"name":"Nicole Reisch","orcid":"0000-0002-7469-6069","position":17,"is_corresponding":false},{"id":239628,"name":"Stefanie Hahner","orcid":"0000-0003-1616-8986","position":18,"is_corresponding":false},{"id":459345,"name":"Simon H. 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