Endocrine Disorders During Pregnancy, An Issue of Endocrinology and Metabolism Clinics of North America

Lois Jovanovič, Rachel Pessah Pollack

Description

This issue of Endocrinology Clinics covers essential updates in a range of common endocrine disorders that are of special concern during pregnancy, as well as endocrine problems that can arise due to pregnancy. A variety of thyroid, pituitary, adrenal, and hypertensive disorders are covered, as well as calcium and bone metabolism disorders during pregnancy and lactation. Diagnosis and treatment of gestational diabetes, and pregestational diabetes are addressed. Iodine disorders in pregnancy and lactation are covered. Hyperprolactinemia and infertility are also addressed. Special concerns of obesity in women with reproductive dysfunction are considered. An in-depth guide to achieving a successful pregnancy with PCOS is provided

Sujets

• Médecine
• Spécialités médicales
• Medical
• Metabolism
• Endocrinology

Informations

• Publié par: Saunders
• Date de parution: 28 décembre 2011
• Nombre de lectures: 0
• EAN13: 9781455709175
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Anesthesiology Clinics , Vol. 40, No. 4, December 2011
ISSN: 0889-8529
doi: 10.1016/S0889-8529(11)00103-4

Contributors
Endocrinology and Metabolism Clinics of North America
Endocrine Disorders During Pregnancy
GUEST EDITOR: Rachel Pessah-Pollack, MD
Lois Jovanovi MD
Mount Sinai School of Medicine, Division of Endocrinology, One Gustave L. Levy Place, Box 1055, New York, NY 10029, USA
Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA 93105, USA
CONSULTING EDITOR: Derek LeRoith, MD, PhD
ISSN  0889-8529
Volume 40 • Number 4 • December 2011

Anesthesiology Clinics , Vol. 40, No. 4, December 2011
ISSN: 0889-8529
doi: 10.1016/S0889-8529(11)00104-6

Contents
Cover
Contributors
Forthcoming Issues
Management of Endocrine Disorders During Pregnancy
Endocrine Disorders During Pregnancy
Diagnosis and Treatment of Hyperglycemia in Pregnancy
Pregnancy Management of Women with Pregestational Diabetes
Thyroid Disorders in Pregnancy
Iodine Nutrition in Pregnancy and Lactation
Adrenal Disorders in Pregnancy
Calcium and Bone Metabolism Disorders During Pregnancy and Lactation
Pituitary Disorders During Pregnancy
Hyperprolactinemia and Infertility
Hypertension in Pregnancy
Achieving a Successful Pregnancy in Women with Polycystic Ovary Syndrome
Obesity and Reproductive Dysfunction in Women
Index
Anesthesiology Clinics , Vol. 40, No. 4, December 2011
ISSN: 0889-8529
doi: 10.1016/S0889-8529(11)00105-8

Forthcoming Issues
Anesthesiology Clinics , Vol. 40, No. 4, December 2011
ISSN: 0889-8529
doi: 10.1016/j.ecl.2011.09.004

Foreword
Management of Endocrine Disorders During Pregnancy

Derek LeRoith, MD, PhD
Division of Endocrinology, Metabolism, and Bone Diseases, Department of Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1055, Altran 4-36, New York, NY 10029, USA
E-mail address: [e-mail]


Derek LeRoith, MD, PhD, Consulting Editor
Pregnancy is associated with numerous alterations of normal physiological processes and many disorders predate the pregnancy, whereas others are affected by the pregnancy. This issue is devoted to those common endocrine disorders that endocrinologists encounter in their practice and those involved in clinical research on these topics.
Drs Inturrisi, Lintner, and Sorem, in their article, discuss the diagnosis and treatment of hyperglycemia in pregnancy. Conceptually, pregnant women with hyperglycemia, whether beginning prior to the pregnancy with a diagnosis of diabetes, or discovered during pregnancy, called gestational diabetes, should be treated in a similar manner. The occurrence is very high and should be suspected and tested for in all women. Complications to the mother and fetus are generally the result of poor control of the metabolic state.
It is clear that uncontrolled hyperglycemia during pregnancy has deleterious effects on the mother and infant and it behooves us to attempt to maintain a normal blood glucose both during the preconceptual period as well as during the pregnancy. Hypoglycemia should similarly be avoided. In general, diet, exercise, and insulin are the mainstay of therapy, while oral agents such as metformin and sulfonylureas have been tested, although not yet recommended, as their effects on the fetus, if any, are uncertain. Drs Mathiesen, Ringholm, and Damm also point out that management of blood pressure and screening for retinopathy and nephropathy is no less critical.
As discussed in their article, Drs Krajewski and Burman make a strong case for maintaining normal thyroid function in pregnancy to ensure the delivery of a normal infant. Perturbations of thyroid function, whether hypothyroid or hyperthyroidism, are deleterious to the fetus and newborn. Hyperthyroidism is treated with thionamides, whereas radioiodine is contraindicated to avoid fetal hypothyroidism. Since thyroid function tests vary during pregnancy, when treating hypothyroidism, constant monitoring is essential for appropriate thyroid hormone replacement.
In their article, Drs Leung, Pearce, and Braverman describe the critical role of an adequate iodine supply required for normal thyroid function during both pregnancy and lactation to ensure normal fetal and postnatal development, especially development of the nervous system. They describe a number of substances that can interfere with normal iodine metabolism as well as present evidence that pregnancy may be associated with an inadequate intake even in the United States; guidelines suggest supplementation with multivitamins containing 150 ug iodine daily during pregnancy.
Because of the hormonal changes that occur during pregnancy, diagnosing hypo- or hyperadrenalism presents a challenge to the clinician. Thus, as discussed by Drs Abdelmannan and Aron, evaluating the hypothalamic-pituitary-adrenal axis as well as the changes in total and free cortisol and alterations in the renin-aldosterone system requires special expertise. Hypoadrenalism may present prior to pregnancy and thus maintenance of normal cortisol levels becomes critical. Alternatively, it may occur during pregnancy following adrenal hemorrhage. Their article gives the clinician a clearer understanding of these issues.
During pregnancy, there are some significant shifts in calcium metabolism. As Dr Kovacs describes in his article, intestinal calcium absorption increases to accommodate the demand made by the placenta and fetus, whereas, during lactation, the increased demand is dealt with by resorption from the skeletal calcium pool. While these changes may affect women during pregnancy, reestablishment of the skeleton occurs rapidly once lactation is complete. Thus, in most cases, the changes in pregnancy are temporary and seldom leave long-lasting effects in calcium homeostasis or bone loss.
Many organs and physiological processes change dramatically during pregnancy and the pituitary is no exception. Enlargement of the pituitary is generally due to hypertrophy and hyperplasia of the prolactin-producing lactotrophs. As discussed in the article by Drs Motivala, Gologorsky, Kostandinov, and Post, the enlargement generally recedes postpartum. They also discuss rare but important issues such as lymphocytic hypophysitis that may occur peripartum, Sheehans syndrome that may occur as a result of postpartum pituitary necrosis secondary to severe hemorrhage, and pituitary apoplexy, with all their sequelae.
Drs Shibli-Rahhal and Schlechte discuss the effect of prolactin on fertility. Hyperprolactinemia, often caused by pituitary adenomas, is commonly associated with abnormal gonadal function clearly affecting both menstruation, with amenorrhea being the symptom, as well as infertility, a serious consequence for young women. Reductions in prolactin levels, either by effective medication or by surgery, often relieves the amenorrhea and infertility. Since the pituitary often enlarges during pregnancy, special attention should be paid to women with prolactinomas who become pregnant as a result of effective medical therapy. The main downside of dopamine agonist therapy is that, while very effective, cessation of therapy often results in remission of the hyperprolactinemia and tumor regrowth.
There are numerous causes of hypertension in pregnancy. Some are associated with preexisting conditions, such as obesity, the metabolic syndrome, and diabetes, in addition to renal causes. On the other hand, preeclampsia, a serious condition, is also common, although, as discussed by Drs Solomon and Seely, the cause is not yet defined. In their article, they discuss screening and management of hypertension and particularly address which antihypertensive medications are appropriate and which can affect the fetus.
Drs Araki, Elias, Rosenwaks, and Poretsky describe the prevalence and clinical diagnosis of polycystic ovarian syndrome. Almost 7%–8% of women suffer from the syndrome that is the commonest cause of infertility in women. Polycystic ovarian syndrome is, of course, a state of hyperandrogenism, but also includes insulin resistance and a measurable elevation in luteinizing hormone. Insulin resistance can be overcome in 50% of women by weight loss and exercise but others need treatment, such as clomiphene, GnRH, or, better still, metformin, that lowers insulin resistance; similarly, so do the thiazolidinediones and GLP-1 agonists. Finally, aromatase inhibition may also be successful. Overall, metformin, sometimes in combination with other medications, gives the best results for ovulation and pregnancy.
Obesity represents a significant factor in reproductive health in women, in addition to the health consequences associated with cardiovascular complications, for example. Obese women are less fertile and attention to weight may help in conception, both with natural methods and with assisted technology. As discussed by Drs Moran, Dodd, Nisenblat, and Norman, even during pregnancy obese women and their offspring are at increased risk for adverse events. Weight loss, of course, is still the best way to prevent these complications.
The readers of this issue will undoubtedly appreciate the value of the articles in this issue as much as I did. They have been written by experts in the field, whose time and efforts are greatly appreciated by the issue editors, Drs Pessah-Pollack and Jovanovi , and me. In particular, the authors have presented basic concepts as well as practical clinical advice.
Anesthesiology Clinics , Vol. 40, No. 4, December 2011
ISSN: 0889-8529
doi: 10.1016/j.ecl.2011.09.003

Preface
Endocrine Disorders During Pregnancy

Rachel Pessah-Pollack, MD
Mount Sinai School of Medicine, Division of Endocrinology, One Gustave L. Levy Place, Box 1055, New York, NY 10029, USA
E-mail address: [e-mail]
E-mail address: [e-mail]

Lois Jovanovi , MD
Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA