Wichtige endokrine Funktionsstörungen bei Schwangeren

Zusammenfassung

Endokrine Störungen haben einen bedeutsamen Einfluss auf die Fertilität, den Verlauf einer Schwangerschaft und die fetale Entwicklung. So ist die Fertilität bei Patientinnen mit Autoimmunerkrankungen, z. B. M. Addison oder der Autoimmunthyreoiditis, eingeschränkt und das Fehlgeburtsrisiko erhöht. Die Behandlung einer endokrinen Störung muss während einer Schwangerschaft häufig angepaßt werden. So muss bei Patientinnen mit einem M. Addison die erforderliche Substitutionsdosis von Hydrocortison erhöht werden. Dies gilt auch für die Entbindung. Von besonderer klinischer Bedeutung sind die Erkrankungen der Schilddrüse. Eine Hypothyreose muß in der Frühschwangerschaft rasch mit Levothyroxin ausgeglichen werden. Eine Jodsupplementierung wird nachhaltig während der Schwangerschaft und der Stillperiode empfohlen. Eine Autoimmunhyperthyreose wird im ersten Trimenon mit Propyluracil, danach mit Methimazol (Thiamazol) behandelt. Bei der durch hCG bedingten Gestationshyperthyreose verbietet sich hingegen eine Thyreostatikatherapie. Die Übersicht beschränkt sich auf die wichtigsten endokrinen Störungen in der Schwangerschaft.

Abstract

Endocrine disorders may have an important influence on fertility, the course of a pregnancy and fetal development. For example, fertility is decreased and the risk of miscarriage is increased in women with autoimmune disorders, such as Addison’s disease or autoimmune thyroiditis. Treatment of endocrine diseases in many cases has to be adapted during the course of a pregnancy. In patients with Addison’s disease the dosage of hydrocortisone necessarily has to be increased. This is also valid for the time of delivery. Disorders of the thyroid gland are of great importance during pregnancy. If hypothyroidism is diagnosed in early pregnancy, immediate treatment with levothyroxine should be initiated. Iodine supplementation is strongly recommended in all pregnant and breast-feeding women. Treatment of Graves’s disease will be performed during the first trimenon with propylthiouracile, afterwards with methimazole (thiamazole). In contrast, thyrotoxicosis due to hCG should not be treated with methimazole. In this paper, we present an overview on the most important endocrine disorders during pregnancy.

Schlüsselwörter

Fertilität - Schwangerschaft - endokrine Störungen - Nebenniereninsuffizienz - Hypothyreose - Hyperthyreose

Keywords

fertility - pregnancy - endocrine disorders - adrenal insufficiency - hypothyroidism - thyrotoxicosis

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