A Case of Cushing's Syndrome in Pregnancy Secondary to an Adrenal Cortical Adenoma

Abstract

Cushing s syndrome in pregnant women is rare and difficult to be diagnosed because of the syndrome's association with oligomenorrhea or amenorrhea and the changes in cortisol metabolism during normal pregnancy. Cushing syndrome in pregnancy is usually confused with complicated pregnancy, such as preeclampsia or gestational diabetes, and its rarity leads to a low degree of clinical suspicion, often delaying diagnosis. We experienced a case of Cushing s syndrome in pregnancy, which had been considered as the severe preeclampsia and gestational diabetes due to uncontrolled hypertension and hyperglycemia. The pregnancy was terminated with an emergency cesarean operation at 30 weeks of gestation because of severe preeclampsia. In consequence of the evaluation about the Cushing s syndrome after delivery, the adrenal cortical adenoma of right adrenal gland was diagnosed and laparoscopic adrenalectomy was performed.

Cushing’s syndrome in pregnancy. Laparoscopic adrenalectomy during pregnancy: the mainstay treatment

“…CS that complicates pregnancy is a high-risk obstetric condition [8] with significant maternal morbidity and mortality (70 %) [1]: hypertension, GD, preeclampsia, osteoporosis, heart failure, psychiatric disorders, HELLP syndrome and maternal death [4,5]. It is also associated with major foetal complications: abortions, prematurity, delayed intrauterine growth, and even neonatal death [5,7].…”

“…Adrenal adenoma is the causative factor in pregnant women in up to 40-50 % of cases [4,5] the reason being that adrenal cortisol production does not alter ovulatory function [5,8]. Mean gestational age at diagnosis is approximately 18 weeks [2].…”

“…The diagnosis of CS during pregnancy is complicated for several reasons: its low incidence requires a high degree of clinical suspicion; screening hypercortisolism is more difficult in pregnant women during the second and third trimesters [4], and the syndrome usually presents the same symptoms as complicated pregnancy (preeclampsia and GD which are much more frequent) [8]. Moreover, in normal pregnancy ACTH, cortisol (C) and UFC increase, which make biochemical diagnosis of CS difficult [5].…”

Cushing’s Syndrome Complicating Pregnancy

“…In many others, however, it has been shown to be ineffective and potentially hazardous. Surgery, on the other hand, has been more uniformly reported to be successful and was recommended by many authors as a first choice79 [1,2,6,[10][11][12][13]. Historically, the optimal time for surgical intervention during pregnancy was the second trimester.…”

Cushing’s syndrome during pregnancy caused by adrenal cortical adenoma: a case report and literature review

“…Unilateral adrenalectomy was performed before delivery in nine [2][3][4][5][6][7][8][9] of these patients (Group B). Conservative management was adopted in the remaining 35 pregnancies (Group A) [10][11][12][13][14][15][16][17].…”