Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 25 , ISSUE S3 ( December, 2021 ) > List of Articles

INVITED ARTICLE

Parturient with Endocrine Disorders in the Intensive Care Unit

Soumya Sarkar, Puneet Khanna

Keywords : Acute adrenal insufficiency, Diabetic ketoacidosis, Myxedema coma, Pheochromocytoma, Pituitary emergencies, Pregnancy, Thyroid storm

Citation Information :

DOI: 10.5005/jp-journals-10071-24055

License: CC BY-NC 4.0

Published Online: 12-01-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Almost every endocrine axis is influenced by pregnancy. The diagnosis in acute cases is challenging as the classical symptoms are often masked. Thyroid storm is found in only 1–2% of hyperthyroid parturients (0.1–0.4% of all pregnancies). Burch and Wartofsky scoring system is useful for the identification of thyroid storms. Myxedema coma is an extremely rare complication of overt hypothyroidism with a 20% mortality rate. Diabetic ketoacidosis usually reported in the second and third trimesters carries a risk of fetal loss in 10–25% of cases. The size of the tumor rises in 2.7% of microprolactinomas and 22.9% of macroprolactinomas during pregnancy. Adrenal insufficiency in pregnancy is usually caused by primary adrenal failure, which is mostly autoimmune in origin. Pheochromocytoma may present as preeclampsia during pregnancy. Unrecognized pheochromocytoma is associated with a maternal mortality rate of 50%. Shared decision-making and close coordination between critical care, anesthesiology, obstetrics, and endocrinology can help in assuring good maternal and fetal outcomes.


PDF Share
  1. Maternal health [Internet]. Unicef.org. 2021 Available from: https://www.unicef.org/india/what-we-do/maternal-health.
  2. Gietka-Czernel M. Thyrotoxicosis and pregnancy. Thyroid Res 2013;6(2):A18. DOI: 10.1186/1756-6614-6-S2-A18.
  3. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017;27(3):315–389. DOI: 10.1089/thy.2016.0457.
  4. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am 1993;22(2):263–277. PMID: 8325286.
  5. Satoh T, Isozaki O, Suzuki A, Wakino S, Iburi T, Tsuboi K, et al. 2016 guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition). Endocr J 2016;63(12):1025–1064. DOI: 10.1507/endocrj.EJ16-0336.
  6. Hodak SP, Huang C, Clarke D, Burman KD, Jonklaas J, Janicic-Kharic N. Intravenous methimazole in the treatment of refractory hyperthyroidism. Thyroid 2006;16(7):691–695. DOI: 10.1089/thy.2006.16.691.
  7. Giles HG, Roberts EA, Orrego H, Sellers EM. Disposition of intravenous propylthiouracil. J Clin Pharmacol 1981;21(11):466–471. DOI: 10.1002/j.1552-4604.1981.tb05651.x.
  8. Jongjaroenprasert W, Akarawut W, Chantasart D, Chailurkit L, Rajatanavin R. Rectal administration of propylthiouracil in hyperthyroid patients: comparison of suspension enema and suppository form. Thyroid 2002;12(7):627–631. DOI: 10.1089/105072502320288500.
  9. Walter RM, Bartle WR. Rectal administration of propylthiouracil in the treatment of Graves’ disease. Am J Med 1990;88(1):69–70. DOI: 10.1016/0002-9343(90)90130-6.
  10. Yeung SC, Go R, Balasubramanyam A. Rectal administration of iodide and propylthiouracil in the treatment of thyroid storm. Thyroid Off J Am Thyroid Assoc 1995;5(5):403–405. DOI: 10.1089/thy.1995.5.403.
  11. American Thyroid Association guideline: treatment of hospitalized patients with hypothyroidism and use of thyroid hormone analogs [Internet]. EndocrineWeb. 2021. Available from: https://www.endocrineweb.com/professional/hypothyroidism/american-thyroid-association-guideline-treatment-hospitalized-patients-h.
  12. Catalano PM, Tyzbir ED, Roman NM, Amini SB, Sims EA. Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women. Am J Obstet Gynecol 1991;165(6 Pt 1):1667–1672. DOI: 10.1016/0002-9378(91)90012-g.
  13. Carroll MA, Yeomans ER. Diabetic ketoacidosis in pregnancy. Crit Care Med 2005;33(10 Suppl.):S347–S353. DOI: 10.1097/01.ccm.0000183164.69315.13.
  14. Fernandez A, Karavitaki N, Wass JAH. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf) 2010;72(3):377–382. DOI: 10.1111/j.1365-2265.2009.03667.x.
  15. Harbeck B, Rahvar AH, Danneberg S, Schütt M, Sayk F. Life-threatening endocrine emergencies during pregnancy–management and therapeutic features. Gynecol Endocrinol 2017;33(7):510–514. DOI: 10.1080/09513590.2017.1307959.
  16. Van der Spuy ZM, Jacobs HS. Management of endocrine disorders in pregnancy. Part II. Pituitary, ovarian and adrenal disease. Postgrad Med J 1984;60(703):312–320. DOI: 10.1136/pgmj.60.703.312.
  17. Biggar MA, Lennard TWJ. Systematic review of phaeochromocytoma in pregnancy. Br J Surg 2013;100(2):182–190. DOI: 10.1002/bjs.8976.
  18. Judy AE, McCain CL, Lawton ES, Morton CH, Main EK, Druzin ML. Systolic hypertension, preeclampsia-related mortality, and stroke in California. Obstet Gynecol 2019;133(6):1151–1159. DOI: 10.1097/AOG.0000000000003290.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.