Which of the following would be a nursing priority for a client just diagnosed with Addisons disease?

What are some implications for pregnancy with Addison’s disease?

Among the many autoimmune diseases, Addison’s stands out as one with an often delayed diagnosis and an explanation that may not be entirely clear to patients. This is because its symptoms are sometimes vague (fatigue, weakness, weight loss, nausea) and it is relatively rare. Also, it affects an unfamiliar but essential body part – the adrenal glands. This, in turn, makes the issue of pregnancy with Addison’s Disease worrisome to many.

In truth, before the advent of steroid treatment, Addison’s did cause very severe complications in pregnancy. With currently available treatment, women with Addison’s may have a slightly higher risk for preterm delivery, small babies and c-sections, but most will have healthy pregnancies and healthy babies.

Addison’s causes an abnormally low production of several hormones which influence metabolism, blood pressure, immune function, sexual maturation, and the sense of overall well-being. During pregnancy, these hormones increase to accommodate changes in the body. The treatment is replacement corticosteroids with or without additional medications for androgen (i.e. testosterone precursor) replacement.

Women are often concerned about ‘taking hormones’ or ‘using steroids’ in pregnancy but one should remember that this is replacing something your body is missing, not adding extra chemicals or un-natural substances to the body. Women need an increase in steroids during labor or for a c-section due to the increased stress on the body and may need to increase levels during the higher-stress, lower-sleep times of newborn parenting.

As with all disease management in pregnancy, it is often useful and recommended to consult with a high-risk obstetrician (Maternal-Fetal Medicine) or an endocrinologist who is comfortable managing pregnant patients. Your midwife or regular doctor can make this referral if you both agree that it would be useful.

If I have Addison’s before getting pregnant, what are some treatment and other considerations while trying to get pregnant?

Before attempting conception, you should be on prenatal vitamins with adequate folic acid (at least 800mcg) for at least three months and your cortisol levels, blood pressure and blood sugar should all be consistently in a normal, healthy range. Addison’s should not interfere with fertility if it is managed. You should also have discussed your plans with you endocrinologist and your midwife or obstetrician. Of course, always work hard toward healthy nutrition, adequate rest and exercise-as-tolerated.

What will happen to my symptoms and treatment while I am pregnant?

Unlike many other autoimmune diseases, Addison’s symptoms are unlikely to be reduced by the immune suppression of pregnancy (for example, some people with RA or lupus notice a decrease in their pain during pregnancy) because the destruction to the adrenal glands has already occurred. Your symptoms should be controlled by your medications though. Typically, medication levels will stay the same in the earlier part of pregnancy and require an increase toward the end of pregnancy and delivery. Levels must be monitored throughout.

What are some signs that I might have onset of Addison’s disease during pregnancy?

Fortunately, this is quite rare. Very severe vomiting, low blood pressure, abnormal blood sugars, tanning or orange discoloration of the skin could all be indicative of Addison’s onset. Any of these in combination with a baby who is not growing well should certainly raise a flag for testing. Unfortunately, aside from the skin discoloration, many of these are common pregnancy complications, as well, so diagnosis could be delayed or missed.

Could the condition worsen during pregnancy or afterward?

Addison’s doesn’t have the progressive degeneration of other, more system-wide autoimmune diseases; once the adrenals are destroyed, they can’t get much worse. However, anytime there is an increase of stress on the body, medications will need to be increased (functioning adrenal glands would naturally increase production of steroids during stress). Once life normalizes, however, most people can resume a fairly standard dose of steroids. Of course, anyone with one autoimmune disease is at higher risk of developing other autoimmune conditions.

Questions for your doctor

• How will my hormone levels be monitored and how often?
• Are there any specific dietary recommendations for Addison’s?
• Do you have any other patients with Addison’s that have had children and might be willing to talk to me?
• Do you have any other support recommendations?

References:
http://emedicine.medscape.com/article/127772-overview#aw2aab6b6
http://www.mayoclinic.com/health/addisons-disease/DS00361/DSECTION=causes
Addison’s disease increases risk for adverse pregnancy outcomes
Björnsdottir S. J Clin Endocrinol Metab. 2010;doi:10.1210/jc.2010-0108.

About the Author
Kathi Kuntz, RN, MSN holds a Bachelor’s and a Master’s Degree in Nursing from the University of Pennsylvania. Her specialization is in the healthcare of women and her graduate research thesis was on autoimmune disease in pregnancy. She has over ten years of clinical practice experience. Currently, Kathi is on an adventure living and traveling with her husband and two young sons in Australia.

This blog post was originally published by AutoimmuneMom.com, written by Kathi Kuntz, RN, MSN, and first published on Sep 24, 2012.

This post contains the opinions of the author. Autoimmune Association is not a medical practice and does not provide medical advice, diagnosis, or treatment. It is your responsibility to seek diagnosis, treatment, and advice from qualified providers based on your condition and particular circumstances. Autoimmune Association does not endorse nor recommend any products, practices, treatment methods, tests, physicians, service providers, procedures, clinical trials, opinions or information available on this website. Your use of the website is subject to our Privacy Policy.

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