Under-treatment of Addison's disease during pregnancy is most likely to lead to which complication?

• A. Adrenal crisis
• B. Preeclampsia
• C. Gestational diabetes
• D. Macrosomia

Answer: (A)

When Addison’s disease is undertreated during pregnancy, the body cannot mount an adequate cortisol response to the extra stress of pregnancy and labor. This increases the risk of an acute adrenal crisis, a life-threatening state from severe cortisol deficiency (and mineralocorticoid imbalance) causing hypotension, dehydration, hyponatremia, hyperkalemia, and hypoglycemia. In pregnancy, the risk is higher because physiological stress escalates cortisol needs, so an adrenal crisis is the most likely serious complication and requires immediate treatment with IV hydrocortisone and fluids.

Preeclampsia involves new-onset hypertension and proteinuria, not a direct result of steroid under-replacement. Gestational diabetes and macrosomia relate to maternal glucose metabolism, not adrenal insufficiency, so they are not the expected consequences of undertreatment in this context.