Female Fertility and Pregnancy Outcomes in Autoimmune Addison's Disease -A Mini Review

Liam O'Murchadha^1,2*Agnieszka Pazderska²

• ¹St. James's Hospital, Dublin, Ireland
• ²Department of Endocrinology, St. James's Hospital, Dublin, Ireland

Autoimmune Addison’s Disease (AAD) is by far the most common cause of primaryadrenal insufficiency in developed countries, occurring more commonly in womencompared with men. The condition is associated with a spectrum of disordersaffecting fertility and reproductive health.Premature ovarian insufficiency (POI) is a clinical condition defined by cessation ofmenstrual cycles and menopausal range gonadotrophins before the age of 40 years.This occurs with a prevalence of 1-2% in the general population, but has beenestimated at 6-10% for women with AAD. One registry study demonstrated that onethird of those with AAD who develop POI, do so before the age of thirty. The onset ofPOI precedes or is contemporaneous with the diagnosis of AAD in the majority. Ithas also been demonstrated that women with AAD are more likely to use hormonereplacement therapy.The pathophysiology of POI in this cohort is thought to be primarily throughautoimmune mediated inflammation of the ovarian theca cells. In particular, cross-reacting autoantibodies to steroid-producing cells (StCA) have been identified whichare present in AAD and POI. That said, when women with POI are excluded, fertilityremain significantly reduced.Impaired adrenal androgenesis and resulting sex-hormone deficiency has also beenimplicated in subfertility in AAD. This leads to suboptimal follicular development.This, in turn, may also affect libido. Despite physiological glucocorticoid replacementtherapy, patients with AAD consistently report reduced quality of life compared tomatched controls. These factors may affect fecundity and likelihood of conception.Other autoimmune conditions such as hypothyroidism and type 1 diabetes occur withincreased prevalence in those with AAD. These conditions have been shown toindependently affect reproductive health.This review focuses on the current understanding of the factors and mechanismsimpacting fertility in women with autoimmune Addison’s disease.