Fetal and maternal adrenals in human pregnancy

Human pregnancy is marked by alterations in several endocrine systems-perhaps most notably, the striking increase in steroid hormone production by the adrenals of the fetus and mother. Morphologically and physiologically, the human fetal adrenal glands are remarkable organs. In proportion to the adult organs, the adrenal cortex is the largest organ of the fetus. At term, they produce more steroid and weigh the same as adrenal glands of the adult. Much of the steroid that is released by the fetal and maternal adrenals during pregnancy is the sulfated form of dehydroepiandrosterone (DHEA-S), which is used by the placenta to produce estrogens. Herein, we discuss the physiologic and pathophysiologic hormonal changes of the fetal and maternal adrenals during the course of pregnancy.