Narrative reviewindependent cross-checkabstract checked I-SRC-129 standard review
Cortisol rises in normal pregnancy
Adrenal insufficiency in pregnancy: Physiology, diagnosis, management and areas for future research.
Overview
Lee JH et al.. Rev Endocr Metab Disord 2023 · PMID 35816262 · DOI 10.1007/s11154-022-09745-6
Normal pregnancy raises cortisol, including the free active form; true adrenal insufficiency is a separate, rare disease.
Does the study support the specific claim? No · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Review adrenal function in pregnancy
- How was the study done?
Narrative review
- How many people, animals or samples were studied?
not applicable
- What was actually found?
Physiological high cortisol in pregnancy
- How large was the observed effect?
not applicable
- What do the results mean in everyday life?
Pregnancy does not cause cortisol deficiency
- What are the study's limitations?
Narrative
- What does it say about Elawady's specific claim?
Contradicts the cortisol part
- Do the results apply to Germany and Europe?
High
Scientific in-depth review
1. Full reference
- Authors
- Lee JH et al.
- Journal
- Rev Endocr Metab Disord
- Year
- 2023
- Identifier
- PMID 35816262 DOI 10.1007/s11154-022-09745-6
- Verification
- verified – PubMed efetch 2026-10-26; Crossref works record checked
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Not stated in record.
2. Research question
How does pregnancy change adrenal function and how is adrenal insufficiency diagnosed and managed in pregnancy?
3. Study design and population
- Study design
- Narrative review – Narrative review
- Population
Pregnant women
- Country
International
- Period
Published 2023
- Sample size
not applicable
- Inclusion and exclusion criteria
not stated
4. Methods and endpoints
- Exposure / intervention
Pregnancy
- Comparator
Non-pregnant state
- Endpoints
HPA-axis physiology; adrenal insufficiency
- Statistical methods
Narrative
5. Actual results
- Results
Pregnancy is a state of sustained physiological hypercortisolaemia due to placental CRH, higher ACTH and increased adrenal responsiveness; despite more CBG, free cortisol increases progressively in pregnancy. Adrenal insufficiency is a specific disease requiring prompt diagnosis; replacement doses often need increasing in the last trimester.
- Absolute risks
not applicable
- Authors' conclusion
Diagnosis and management of adrenal insufficiency must reflect the physiological rise of cortisol in pregnancy.
6. Strengths
- Expert endocrine review
7. Weaknesses
- Narrative
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Narrative but consistent with measured data (I-INTB-22).
9. Assessment of the statistical interpretation
Not applicable.
10. Relevance to the specific claim
Directly contradicts 'pregnancy causes cortisol deficiency': normal pregnancy raises total and free cortisol; true adrenal insufficiency is a rare disease that needs treatment.
11. Independent contrary findings
12. Transferability to Germany and Europe
Applicable.
13. Overall methodological judgement
Supports existing verdict.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
15. Linked fact checks
- Pregnant women develop health problems because pregnancy causes cortisol deficiency and raised intra-abdominal pressure. – Studies contradicting or limiting the claim