Management of Elevated DHEA and Cortisol in Pregnancy

Critical Monitoring and Management

Only 10% of maternal corticosteroid dose reaches the developing fetus, according to the American Association for the Study of Liver Diseases 1, 2, 3
Clinical signs of Cushing's syndrome, such as rapid weight gain, moon facies, purple striae, proximal muscle weakness, and hypertension, should be investigated 1
Virilization symptoms, including hirsutism, voice deepening, and clitoral enlargement, may indicate an androgen-secreting tumor 1
Imaging findings, such as an adrenal mass >4-5 cm, irregular margins, or heterogeneous appearance on ultrasound/MRI, require further evaluation 4
Pregnant women with glucocorticoid exposure should be screened for gestational diabetes mellitus, as elevated cortisol increases the risk of GDM 1, 2, 3, 5
Blood pressure should be monitored throughout pregnancy, as elevated cortisol may contribute to hypertension 1, 2, 3
No glucocorticoid supplementation is needed for physiologic cortisol elevation at delivery 1, 2
Stress-dose steroids should be considered only if the patient has been on exogenous glucocorticoids >5 mg prednisolone daily for >3 weeks 1, 2, 3, 5, 6
Ketoconazole (400-1200 mg/day) can inhibit adrenal steroidogenesis, but requires regular liver function monitoring 4
The Endocrine Society recommends monitoring for signs of adrenal insufficiency with any adrenostatic agent 4