Adrenal insufficiency

During pregnancy, the hypothalamic-pituitary-adrenal (HPA) axis undergoes significant changes. Cortisol levels increase well above nonpregnant values. Diagnosis of new-onset adrenal insufficiency during pregnancy requires a high index of suspicion and an understanding of the physiologic changes expected during this period. Management of known adrenal insufficiency during pregnancy is predicated upon knowledge of the same physiologic adaptations expected during pregnancy but also calls for frequent surveillance of clinical features suggestive of under- or over-replacement of glucocorticoids and mineralocorticoids.