Treatment of Central Adrenal Insufficiency During Pregnancy

This protocol covers glucocorticoid management in pregnant patients who have pre-existing central adrenal insufficiency. Pregnancy imposes evolving physiological demands that directly affect replacement requirements, and close monitoring for signs of both over- and under-replacement is essential throughout gestation and at delivery.

Patients with central adrenal insufficiency require careful surveillance during each trimester and at the time of labor and delivery. Glucocorticoid needs may shift as pregnancy progresses, and the approach to dosing during delivery differs from routine replacement. Monitoring focuses on clinical symptoms and signs of both deficiency and excess.

Hydrocortisone is the preferred glucocorticoid in this population, with dosing individualized to the patient's clinical course. Specific adjustments are required as pregnancy advances, and a distinct stress-dosing strategy applies during active labor and operative delivery. The complete protocol specifies what those adjustments involve and which agents are not appropriate in pregnancy.

• Normal weight gain
• Absence of fatigue
• Absence of postural hypotension or hypertension
• Absence of hyperglycemia