Parturition in two pregnant women with Addison's disease: changes of plasma corticotropin releasing factor levels

Objectives Addison's disease is characterized by a primary adrenocortical i nsufficiency associated with a derangement of the hypothalamus-pituitary-ad renal axis. Before identification of cortisone supplementation therapy, onl y a few cases of pregnancy in Addison's patients were described. Indeed hum an pregnancy is characterized by a physiological state of hypercortisolemia . Corticotropin releasing factor (CRF) is a hypothalamic peptide which regu lates the pituitary-adrenal cortex axis, and which is also produced during pregnancy by the human placenta, fetal membranes and decidua. In healthy wo men, a progressive increase of plasma CRF levels throughout gestation occur s, reaching the highest values at term and during labor, so that a placenta l source has been suggested. Patients and methods The present study aimed to examine the modification of maternal CRF plasma levels at term and at parturition in two women with Ad dison's disease. In one patient, the disease was associated with an autoimm une hypothyroidism. Both patients had a normal pregnancy, spontaneous labor , vaginal delivery and a regular postpartum period. Plasma CRF levels were measured during the third trimester of pregnancy (at 32, 36, 40 weeks) in C ase 1, while in Case 2 blood samples were drawn at the end of gestation, du ring labor, at delivery and from the umbilical cord. A group of normal preg nant women (n = 5) was used as a control group. Results Plasma CRF levels during pregnancy did not differ between the Addis on's patients and the healthy controls, showing a progressive increase in b oth groups during the last weeks of gestation. During labor and at delivery , a further significant increase of CRF plasma levels was observed in Case 2. Conclusion These data indicate that the placental CRF pathway was not modif ied in these two patients with Addison's disease.