PREGNANCY IN ADDISON'S DISEASE: REPORT OF FOUR PATIENTS

Abstract

INTRODUCTION THE occurrence of pregnancy in patients with Addison's disease presents certain features of physiologic interest and poses several problems in therapy. Most standard textbooks state that the maternal adrenals enlarge in pregnancy, though their contribution to the normal progress of gestation remains for the most part unknown. An approach to this problem has been made by Venning by determining urinary excretion of substances derived from the adrenal in 9 normal pregnant women (1). In the first trimester of pregnancy a temporary increase was observed in the excretion of glycogenic corticoids to more than double that found in normal non-pregnant women, but early in the second trimester, there was a return to the values found before pregnancy. A second and greater rise to 5 times these values was noted in the latter part of pregnancy, with finally a fall before delivery. The 17-ketosteroid excretion increased gradually throughout pregnancy when assayed with m-dinitrobenzene (Zimmermann reaction). This increase was interpreted by Venning as due to an increase in 20-ketosteroids rather than in 17-ketosteroids, since the latter as determined with antimony trichloride (Pincus method) remained unaltered.