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Inflammatory Bowel Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Prednisone and budesonide are commonly used to treat flares. Due to pregnancy risks and long-term health risks, corticosteroids are not appropriate for maintenance therapy [3, 30]. First trimester exposure is associated with an increased risk of orofacial clefting, and use during this time period should be avoided or limited to the lowest effective dose. Corticosteroid use is also associated with an increased risk of low birthweight, gestational diabetes, and preterm birth [33, 46, 47]. Budesonide is generally safe in pregnancy and with breastfeeding. Prednisone is generally safe with breastfeeding, but women on high doses should avoid breastfeeding within 4 hours of taking their dose to minimize possible neonatal effects. High-dose prednisone confers risk of diabetes (early glucola is warranted) and PPROM. A steroid taper is recommended when used for more than 1 week. Stress dose steroids are indicated only in special circumstances.
Inflammatory bowel disease
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Aimee G. Kim, Samir K. Gadepalli, James D. Geiger
After surgery, nasogastric decompression, if in place, may be removed on postoperative day 1, and enteral feedings can be advanced as tolerated. If the child has been malnourished, consideration should be given to continued postoperative parenteral nutrition. The Foley catheter in proctocolectomy and pull-through patients is usually removed on postoperative day 2 or day 3, but it may be left longer if the pelvic dissection was difficult. Patients in whom stress-dose steroids were administered should have their doses tapered over weeks. Initiation or continuation of other immunomodulatory or biologic therapy after surgery should be discussed with the gastrointestinal team and arranged prior to discharge if indicated. Children with new ostomies should receive routine stoma care and teaching for both patients and families.
Disorders of the renal system
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Glucocorticoids are usual maintenance medication for women following transplant. Depending on the dosage given, stress dose steroids may be given during labour. Caesarean section is common in those women who have had a transplant, and this may represent the high rate of PET, IUGR and potential for a deteriorating condition. It is vital that an accurate assessment of where the donor organ is situated, and whether the original organ remains, is undertaken before any procedure is carried out. The midwife needs to ensure these records are available for every woman, as even planned vaginal deliveries may turn into a Caesarean section. Transplant surgeons often attend Caesarean sections to offer obstetricians specialist advice.
Pediatric pituitary adenoma with mixed FSH and TSH immunostaining and FSH hypersecretion in a 6 year-old girl with precocious puberty: case report and multidisciplinary management
Published in International Journal of Neuroscience, 2022
Marco Ceraudo, Diego Criminelli Rossi, Natascia Di Iorgi, Armando Cama, Gianluca Piatelli, Alessandro Consales
Abdominal ultrasound showed increased volume of uterus and ovaries with a multifollicular pattern. Left wrist x-ray revealed that bone age was 2 years and 7 months advanced respect chronological age. Diagnosis of rapidly progressive precocious puberty, difficult to control under Triptorelin therapy, and central hypothyroidism were confirmed. L-thyroxin therapy was started (25 mcg 20 min before breakfast). After few days on L-thyroxin the patient presented vomiting and a slight hyponatremia (134 mEq/L): an ACTH low test (Synacthen 1 mcg/m2) revealed normal-low baseline values of ACTH (8.9 pg/ml) and cortisol (6.86 µg/dl), but an insufficient cortisol response (14.58 µg/dl after 30 min, 15.03 µg/dl after 60 min, normal peak response >22 µg/dl) that was suggestive of central adrenal insufficiency [13]. Patient started cortisol replacement with a stress dose of hydrocortisone (20 mg/m2).
Hypophysitis related to immune checkpoint inhibitors: An intriguing adverse event with many faces
Published in Expert Opinion on Biological Therapy, 2021
Maria V Deligiorgi, Charis Liapi, Dimitrios T Trafalis
Glucocorticoids at stress doses should be administered to any patient with known secondary adrenal insufficiency presenting with acute adrenal crisis or severe illness, or empirically to critically ill patients with suspected secondary adrenal insufficiency. In case of suspected secondary adrenal insufficiency, measurement of cortisol levels and ACTH levels should be ordered before initiation of glucocorticoids, but the treatment should be initiated without waiting the results. A typical stress dose of corticosteroids includes an initial dose of 100 mg HC IV followed by 50 mg HC IV every 6 h. Following amelioration of patient’s clinical status, this regimen can gradually be tapered to typical maintenance dose of HRT. In case of suspected secondary adrenal insufficiency, once the state of patient is stable, a corticotropin stimulation test (short Synacthen test [SST]) should be conducted after temporary cessation of HC for 24 hours. If central adrenal insufficiency is confirmed, the patient will receive typical maintenance HRT dose. Dexamethasone at a stress-dose of 4 mg is preferred over HC for emergent treatment of suspected secondary adrenal insufficiency grade 3–4 on presentation, since it does not interfere with the cortisol assay. If the diagnosis is confirmed, HC 100 mg can be used [96].
Spontaneous preoperative pituitary adenoma resolution following apoplexy: a case presentation and literature review
Published in British Journal of Neurosurgery, 2020
Daniel G. Eichberg, Long Di, Ashish H. Shah, William A. Kaye, Ricardo J. Komotar
Thickened and gadolinium-enhancing sphenoid sinus mucosa as seen on MRI may aid in the diagnosis of PA, and, if present, may indicate a worse grade of PA with associated poor neurologic and endocrinologic outcomes.40 Subarachnoid hemorrhage from aneurysmal rupture may also cause acute headache, opthalmoplegia, and altered level of consciousness, and so must be ruled out before confirming the diagnosis of PA.41 Once PA is diagnosed, stress dose corticosteroids should be administered immediately, and fluid balance and electrolytes should be monitored.39 Studies have shown that neurologic outcomes are optimized if decompressive surgery is performed within seven days of onset of PA involving rapid progression of neurologic deficits,42 and ideally emergently with as little delay as possible.