ABSTRACT
Pregnancy results in major changes in the hypothalamo-pituitary-adrenal (HPA) axis,
which in turn influence fetal growth and the timing of labor. From the beginning of
the second trimester maternal cortisol secretion increases, and in late pregnancy
the placenta, in large part mediated through corticotroph-releasing hormone, plays
a crucial role in the regulation of the fetal HPA axis to ensure the synchronization
of the various processes involved in parturition. Exposure of the fetus to excess
glucocorticoid results in intrauterine growth failure and possibly "programs" the
development of cardiovascular disease in adult life. Biochemical assessment of the
HPA axis is complicated by the estrogen-induced elevation of circulating cortisol-binding
globulin, resulting in misleadingly high circulating cortisol levels The hypercortisolemia
of Cushing's syndrome causes infertility, but if pregnancy does occur it can result
in increased morbidity and mortality in mother and fetus. However, the prospects of
a successful pregnancy are greatly improved with control of hypercortisolemia by surgery
and medical therapy with metyrapone. Hypoadrenalism can be difficult to diagnose during
pregnancy but, once the diagnosis is made, with careful monitoring, dose adjustment
as indicated, and parenteral cover for labor, a successful pregnancy should result.
KEYWORD
Pregnancy - cortisol - Cushing's syndrome - Addison's disease
