Gebelik ve Addison Hastalığı
Özet
Addison hastalığı, adrenal korteksin yıkımı sonucu adrenal bezler tarafından glukokortikoid ve mineralokortikoidlerin yetersiz üretimiyle karakterize nadir bir hastalıktır. Adrenal yetmezlik; kronik olarak yaygın semptomlara neden olmakla birlikte, özellikle fizyolojik glukokortikoid ihtiyacının arttığı dönemlerde adrenal kriz olarak bilinen yaşamı tehdit edici kliniğe neden olabilir. Bu nedenle sürekli değişen fizyolojik ihtiyaç gözetilerek glukokortikoid ve mineralokortikoid replasman tedavisi doz planlamasının yönetilmesi gerekir. Gebelikte Addison hastalığı; artmış adrenal kriz riski, preterm doğum, düşük doğum ağırlığı ve artan sezaryen doğum oranı gibi komplikasyonlarla ilişkili bulunmuştur. Addison hastalığına özgü kronik semptomların gebeliğe özgü atfedilen yorgunluk, bulantı-kusma, halsizlik ve kilo kaybı gibi semptomlar ile örtüşmesi nedeni ile tanı gebelikte zorlaşır. Ayrıca adrenal krizler gebelik süresince artan fizyolojik stres ve fizyolojik değişiklikler nedeniyle özellikle; ilk trimester, doğum ve puerperium gibi dönemlerde görülme eğilimindedir. Bu nedenle gebelikte Addison hastalarının semptomlarının düzenli aralıklarla takibi yapılarak ve gebeliğin trimesterine göre ihtiyaç göz önünde bulundurularak replasman dozu düzenlenmelidir. Ayrıca doğum, puerperium, cerrahi, enfeksiyon gibi dönemlerde artan fizyolojik stres nedeni ile stres düzeyi dozlar ile tedavi yönetilmelidir. Doğum sonrası ilaç düzeyleri hasta takip edilerek ayarlanır. Uygun yönetimle takip edilen gebelerde adrenal kriz riski azalır. Maternal ve fetal komplikasyonlar en aza indirilir.
Addison's disease is a rare disorder characterized by inadequate production of glucocorticoids and mineralocorticoids by the adrenal glands as a result of destruction of the adrenal cortex. Adrenal insufficiency causes chronic widespread symptoms and can also lead to a life-threatening clinical picture known as adrenal crisis, especially during periods when physiological glucocorticoid requirements increase. Therefore, glucocorticoid and mineralocorticoid replacement therapy dose planning should be managed by considering the ever-changing physiological needs. Addison's disease in pregnancy has been associated with complications such as increased risk of adrenal crisis, preterm birth, low birth weight, and increased cesarean delivery rate Diagnosis becomes difficult during pregnancy because of the overlap of chronic symptoms specific to Addison's disease with symptoms attributed to pregnancy. Additionally, adrenal crises tend to occur during periods such as the first trimester, birth, and puerperium, due to increased physiological stress during pregnancy. For this reason, the symptoms of Addison's disease should be monitored at regular intervals during pregnancy and the replacement dose should be adjusted according to the need according to the trimester of pregnancy. In addition, treatment should be managed with stress level doses due to increased physiological stress during periods such as birth, puerperium, surgery, and infection.
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