Gebelikte Diğer Endokrin Hastalıklar
Özet
Gebelikte endokrin hastalıkların tanı ve takibi, hormonal değişiklikler nedeniyle zorlaşmakta ve bu durum maternal-fetal morbidite riskini artırmaktadır. Doğurganlık çağında en sık görülen hipofizer tümör olan prolaktinomada, gebelikte asemptomatik mikroadenomlar izlenirken, semptomatik makroadenomlarda dopamin agonistleri veya cerrahi gerekebilir. Nadir görülen akromegalide gebelikte adenom büyüme riski mevcut olup, preeklampsi ve erken doğum gibi komplikasyonlar gelişebilir; tedavisinde dopamin agonistleri tercih edilir. Diabetus insipitus ise poliüri ve polidipsi ile karakterizedir; santral tipin tedavisinde desmopressin kullanılırken, gestasyonel tip doğum sonrası kendiliğinden düzelir. Postpartum kanamaya bağlı gelişen Sheehan sendromu laktasyon eksikliği ve amenore ile; hipofiz apopleksisi ise şiddetli baş ağrısı ve görme bozukluğu ile kendini gösterir. Cushing sendromu glukoz intoleransı ve preeklampsi gibi riskler taşırken, tedavisi ikinci trimesterde cerrahidir. Otoimmün veya tüberküloz kaynaklı adrenal kortikal yetmezlikte (Addison) gebelikte hidrokortizon replasmanı tercih edilir. Katekolamin üreten feokromasitoma tedavisinde fenoksibenzamin güvenli kabul edilirken, primer aldosteronizmde standart antihipertansifler kullanılır. Son olarak, paratiroid hastalıklarından primer hiperparatiroidizm yenidoğan tetanisine yol açabilirken, hipoparatiroidi tedavisinde yüksek doz D3 vitamini ve kalsiyum desteğiyle normal kalsiyum düzeylerinin korunması hedeflenir.
The diagnosis and management of endocrine diseases during pregnancy become challenging due to hormonal changes, increasing the risk of maternal-fetal morbidity. In prolactinoma, the most common pituitary tumor in reproductive-aged women, asymptomatic microadenomas are monitored during pregnancy, whereas symptomatic macroadenomas may require dopamine agonists or surgery. Acromegaly, a rare condition, carries a risk of adenoma growth during pregnancy and can lead to complications such as preeclampsia and preterm birth; dopamine agonists are preferred for its treatment. Diabetes insipidus is characterized by polyuria and polydipsia; central type is treated with desmopressin, while gestational diabetes insipidus resolves spontaneously postpartum. Sheehan syndrome, developing due to postpartum hemorrhage, presents with lack of lactation and amenorrhea, whereas pituitary apoplexy manifests with severe headache and visual impairment. Cushing's syndrome carries risks like glucose intolerance and preeclampsia, and its treatment is surgical during the second trimester. In adrenal cortical insufficiency (Addison's disease) caused by autoimmune factors or tuberculosis, hydrocortisone replacement is preferred during pregnancy. For the catecholamine-producing pheochromocytoma, phenoxybenzamine is considered safe, whereas standard antihypertensives are utilized in primary aldosteronism. Lastly, among parathyroid disorders, primary hyperparathyroidism can cause neonatal tetany, while the treatment of hypoparathyroidism aims to maintain normal calcium levels through high-dose vitamin D3 and calcium supplementation.
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