adrenal in pregnancy

Overview

Your adrenal glands are two small hormone-making organs that sit on top of your kidneys. They help control blood pressure, blood sugar, stress responses, and salt and water balance. During pregnancy, the body’s hormone needs change a lot, so adrenal gland problems can become more obvious or harder to manage. Some women have an adrenal condition before pregnancy, and others develop one while pregnant. This article explains what adrenal gland problems in pregnancy can look like and how they are managed.

Adrenal gland disorders during pregnancy are rare, but certain types, like underactive adrenal glands, can become more likely to cause problems at this time.

This condition affects women who are pregnant and have a pre-existing adrenal disorder, or women who develop an adrenal hormone imbalance during pregnancy. It can also affect women who have used long-term steroid medicines and then stop them suddenly.

Symptoms

Common symptoms

• Extreme tiredness that does not improve with rest
• Dizziness or light-headedness when standing up
• Nausea, vomiting, or poor appetite
• Low blood pressure
• Salt cravings
• Muscle weakness
• Weight loss or trouble gaining weight
• Darkening of the skin on the face, elbows, or skin creases in some adrenal disorders

Symptoms in children

• If a newborn or child has an adrenal problem, signs can include poor feeding, persistent vomiting, dehydration, low blood sugar, and unusual tiredness. In an older child, being unusually weak, confused, or faint needs urgent care.

Symptoms in older adults

• In older pregnant women, symptoms such as dizziness, fatigue, and low blood pressure may be mistaken for normal pregnancy or ageing. Tell your provider about any new or worsening symptom.

Causes

Main causes

• Pregnancy itself changes how the adrenal glands behave because the placenta makes hormones that affect the mother’s body.
• Autoimmune damage, where the body’s own immune system mistakenly attacks the adrenal glands.
• Severe infections that can damage the adrenal glands.
• Problems with the pituitary gland, a small gland in the brain that controls the adrenal glands.
• A growth or tumour on the adrenal gland that produces too much of a hormone.
• Stopping long-term steroid treatment too quickly can leave the adrenal glands unable to respond.

Risk factors

• Having an autoimmune condition such as type 1 diabetes or thyroid disease
• Taking long-term steroids and stopping them abruptly
• A family history of adrenal disease or autoimmune disease
• A previous adrenal crisis or unexplained very low blood pressure
• Previous surgery or radiation involving the adrenal glands or pituitary gland

When to see a doctor

See a doctor urgently if:

• If you faint, have severe vomiting, feel extremely weak, or have very low blood pressure, call your local emergency number right away.
• If you are being treated for a known adrenal condition and you get a fever, infection, injury, or severe stress, contact your healthcare team the same day.
• If you have symptoms of an adrenal crisis, do not wait.

Book a routine appointment if:

• If you have an adrenal condition and are planning a pregnancy, talk to your specialist before you become pregnant.
• In early pregnancy, make an appointment to review your medicines and care plan.
• If you have a family history of adrenal disease and develop new symptoms, ask your doctor for a check-up.

Diagnosis

Your doctor will ask about your medical history and symptoms, check your blood pressure, and do blood and urine tests. An endocrinologist, a hormone specialist, and an obstetrician often work together to guide your care during pregnancy.

Tests that may be done

• Blood tests to measure hormone levels such as cortisol and related adrenal chemicals
• Urine tests to check for abnormal hormone levels
• Blood pressure monitoring at appointments and sometimes at home
• Imaging of the adrenal glands, such as ultrasound or MRI, if needed; these can be used safely in pregnancy when necessary

What to expect at your appointment

Testing is generally safe during pregnancy. Some tests require fasting, and results may take a few days. Your healthcare team will explain each test and what the results mean for you and your baby.

Treatment

Treatment depends on the specific adrenal problem and how far along you are in pregnancy. The goals are to keep hormone levels balanced, prevent an adrenal crisis, and support a healthy pregnancy.

Self-care at home

• Follow your care team’s sick-day plan if you feel unwell or have vomiting or diarrhoea
• Take your prescribed medicines exactly as directed; never stop them suddenly
• Keep regular meals and snacks; your provider may advise adding salt to your food if you are losing too much salt
• Wear or carry medical alert information about your condition
• Tell every member of your healthcare team, including anaesthetists if you have surgery or go into labour, about your adrenal condition

Medical treatments

Hormone replacement therapy is the usual approach. It may be given by mouth or by injection to replace the hormones your body cannot make. Doses may increase during pregnancy, especially in the third trimester and during labour, when the body needs more cortisol. If an adrenal crisis happens, hospital care may include intravenous fluids, glucose, and emergency steroids.

When is surgery considered?

If a tumour on the adrenal gland is causing too much hormone, surgery may be considered. Your team will plan the timing carefully—sometimes before pregnancy, sometimes during pregnancy, and sometimes after delivery—depending on the tumour, your symptoms, and how the baby is developing.

Living with this condition

Living with an adrenal condition during pregnancy means staying in close contact with your healthcare team and watching for early warning signs. Keep all appointments and tell those close to you how to recognise when you need urgent help.

Lifestyle tips

• Keep a regular routine with meals, rest, and gentle sleep habits
• Manage stress with breathing exercises, gentle movement, or talking to someone you trust
• Avoid becoming too tired; ask for help with household tasks
• Carry a record of your condition and medicines with you
• Review your sick-day plan and steroid plan before labour begins

Diet and exercise

Eat a balanced diet with regular meals and snacks. Your provider may suggest more salt if your kidneys are losing too much. Gentle walking and pregnancy-safe exercises can help with energy and mood, but always check with your healthcare team first.

Mental health and emotional wellbeing

Pregnancy is an emotional time, and living with a long-term adrenal condition can add worry and stress. It is normal to feel anxious, low, or overwhelmed. If you feel this way, tell your midwife or doctor—they can help you access emotional support.

Prevention

Most adrenal disorders cannot be prevented because they are caused by autoimmune, genetic, or other factors. What can be prevented, or at least reduced, are emergencies brought on by the condition. Planning pregnancy care early is the best way to reduce risks.

Vaccines

There is no vaccine that prevents adrenal gland disorders. Having up-to-date routine vaccines is part of general pregnancy care; talk to your healthcare provider about which ones are safe for you.

Screening programmes

If you have a family history of adrenal disease or a known autoimmune condition, ask your doctor whether checking adrenal function is appropriate. During pregnancy, regular blood pressure checks are part of screening for adrenal-related problems.

Complications

If left untreated

• Adrenal crisis: a life-threatening drop in hormones that causes low blood pressure, shock, and confusion
• Poor weight gain or poor growth for the baby
• Preterm birth
• Very low blood sodium
• Dangerous high or low blood pressure if an adrenal tumour is producing excess hormones

Long-term outlook

With a well-planned care team and close monitoring, most women with adrenal conditions have successful pregnancies and healthy babies. The key is early diagnosis, following your treatment plan, and telling your team about any change in symptoms.

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