Document Detail

Treating fetal thyroid and adrenal disorders through the mother.
MedLine Citation:
PMID:  18981991     Owner:  NLM     Status:  MEDLINE    
Advances in imaging techniques and in molecular diagnosis have enabled the identification in the fetus of disorders of thyroid and adrenal function that can potentially be treated in utero through the mother. In women with Graves disease, the rare instances of autoimmune fetal hyperthyroidism can generally be treated in a noninvasive way by optimizing treatment of the mother. For fetal hypothyroidism with goiter leading to hydramnios, repeated intra-amniotic injections of thyroxine have been reported to decrease the size of the fetal thyroid, but experience is limited and the risk of premature labor is raised. In women who have previously borne a child with severe congenital adrenal hyperplasia, attempts to prevent virilization of the external genitalia of further affected female fetuses involves treatment with high doses of dexamethasone from week 7 of gestation to term, which includes the crucial period of organogenesis. Only one of every eight fetuses treated will, however, benefit from this therapy, meaning that seven are unnecessarily exposed to this potentially harmful agent. In this article, we review the rationale and evidence for efficacy of these approaches, and discuss their potential adverse effects as well as the ethical problems that they raise.
Guy Van Vliet; Michel Polak; E Martin Ritzén
Publication Detail:
Type:  Journal Article; Review     Date:  2008-11-04
Journal Detail:
Title:  Nature clinical practice. Endocrinology & metabolism     Volume:  4     ISSN:  1745-8374     ISO Abbreviation:  -     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-21     Completed Date:  2009-04-16     Revised Date:  2009-04-19    
Medline Journal Info:
Nlm Unique ID:  101261798     Medline TA:  Nat Clin Pract Endocrinol Metab     Country:  England    
Other Details:
Languages:  eng     Pagination:  675-82     Citation Subset:  IM    
Department of Pediatrics, University of Montreal, Montreal, QC, Canada.
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MeSH Terms
Adrenal Hyperplasia, Congenital / diagnosis,  drug therapy,  pathology
Fetal Diseases / diagnosis*,  drug therapy*,  pathology
Hypothyroidism / diagnosis,  drug therapy,  pathology
Prenatal Care / methods*
Prenatal Diagnosis
Thyroid Gland / drug effects*,  embryology,  pathology
Erratum In:
Nat Clin Pract Endocrinol Metab. 2009 Feb;5(2):122

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