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16 - Rare endocrine disorders

from Section 4 - Metabolic disorders

Published online by Cambridge University Press:  19 October 2009

By
J. M. Mhyre  and
L. S. Polley
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Robert S. F. McKay
J. M. Mhyre
Affiliation:
Robert Wood Johnson Clinical Scholar, Lecturer, Department of Anesthesiology, Division of Obstetrical Anesthesiology
L. S. Polley
Affiliation:
Associate Professor of Anesthesiology, Director, Obstetric Anesthesiology, University of Michigan, Health System F3900, Mott Children's Hospital, Ann Arbor, MI, USA
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay
Affiliation:
University of Kansas
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Summary

Introduction

Endocrinopathies can complicate pregnancy with adverse maternal and fetal effects. Pregnancy can mask or mimic signs and symptoms of endocrine disease making diagnosis difficult.

Thyroid disease

Hyperthyroidism

Hyperthyroidism is relatively common in the general population and occurs in 2 of 1000 pregnancies. Graves disease causes 80–95% of cases of hyperthyroidism in pregnancy. Other causes include thyroiditis, toxic adenoma, multinodular goiter, viral thyroiditis, and tumors of the pituitary or ovary. Human chorionic gonadotropin (hCG), which peaks between 8 and 14 weeks, weakly stimulates thyroid stimulating hormone (TSH) receptors, and in some cases leads to transient hyperthyroidism associated with hyperemesis gravidarum. High levels of hCG with clinical hyperthyroidism may also be seen with gestational trophoblastic disease and multiple pregnancies.

Subclinical hyperthyroidism occurs in pregnancy (1.7% of all screened women), and, in the general population, has long-term sequelae such as osteoporosis, cardiovascular morbidity, and progression to overt thyrotoxicosis. These women have suppressed TSH but normal free thyroxine (T4) levels. African-American and parous women are more likely to be affected, but there are no adverse pregnancy outcomes. Identification of subclinical hyperthyroidism and treatment during pregnancy is unwarranted.

Thyrotoxic crisis (thyroid storm)

Thyroid storm is the most serious complication of hyperthyroidism. This exaggerated hypermetabolic state occurs in 2% of pregnancies complicated by hyperthyroidism with a reported maternal mortality rate of 15% and a 24% rate of stillbirth. Thyroid storm is often precipitated in women with Graves thyrotoxicosis by common obstetric complications such as hemorrhage, severe preeclampsia, and sepsis.

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Obstetric Anesthesia and Uncommon Disorders , pp. 275 - 292
Publisher: Cambridge University Press
Print publication year: 2008

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  • Rare endocrine disorders
    • By J. M. Mhyre, Robert Wood Johnson Clinical Scholar, Lecturer, Department of Anesthesiology, Division of Obstetrical Anesthesiology, L. S. Polley, Associate Professor of Anesthesiology, Director, Obstetric Anesthesiology, University of Michigan, Health System F3900, Mott Children's Hospital, Ann Arbor, MI, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.017
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  • Rare endocrine disorders
    • By J. M. Mhyre, Robert Wood Johnson Clinical Scholar, Lecturer, Department of Anesthesiology, Division of Obstetrical Anesthesiology, L. S. Polley, Associate Professor of Anesthesiology, Director, Obstetric Anesthesiology, University of Michigan, Health System F3900, Mott Children's Hospital, Ann Arbor, MI, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.017
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Rare endocrine disorders
    • By J. M. Mhyre, Robert Wood Johnson Clinical Scholar, Lecturer, Department of Anesthesiology, Division of Obstetrical Anesthesiology, L. S. Polley, Associate Professor of Anesthesiology, Director, Obstetric Anesthesiology, University of Michigan, Health System F3900, Mott Children's Hospital, Ann Arbor, MI, USA
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.017
Available formats
×