PREGNANCY IN ADDISON'S DISEASE

THE occurrence of pregnancy in a patient with Addison’s disease is a rare event. Knowlton, Mudge, and Jailer (1949) described their experience in the management of 5 cases and were able to collect reports of 39 others, but in some of the reports to which they refer the diagnosis of Addison’s disease is open to question. Brent (1950) also quoted 39 cases in the literature and added another which terminated fatally at Caesarean section. In the Simpson Memorial Maternity Pavilion in Edinburgh, where there is an average of about 3,000 births a year, only 2 patients suffering from Addison’s disease have been delivered in the past 20 years. The patient with Addison’s disease has to face serious hazards in pregnancy. During the first trimester vomiting is liable to occur which may precipitate an Addisonian Crisis. During labour the stresses of physical exertion, haemorrhage, pain, and anaesthesia are inadequately borne, and in the early puerperium the physiological diuresis and excretion of sodium may again encourage the development of an Addisonian crisis. Moreover, in cases due to tuberculous destruction of the adrenals there is a danger of exacerbation or spread of the s e c tion. The introduction of cortisone offers the physician a new weapon with which to ward off these hazards, and this paper describes its use in a case of pregnancy in Addison’s disease.