Approach to Cushing’s syndrome in pregnancy: two cases of Cushing’s syndrome in pregnancy and a review of the literature

Abstract

Cushing's syndrome (CS) rarely occurs during pregnancy. The primary aim of this article is to propose a therapeutic approach to CS in pregnancy. Here, we present two cases of CS in pregnancy and a literature review. This article proposes the early diagnostic points, especially the clinical approach to this medical condition, mainly for pregnant women without a previous diagnosis of CS. More importantly, we present therapeutic strategies for CS during pregnancy, especially glucocorticoid replacement for perioperative, postoperative, and perinatal periods in pregnant women with CS in order to minimize complications for both mother and fetus. At the same time, we also assess the anxiety status of patients. This article summarizes the approach to CS in pregnancy, not only with a physiological assessment but with a psychological assessment as well.

Analysis of clinical and pathological features of primary bilateral macronodular adrenocortical hyperplasia compared with unilateral cortisol-secreting adrenal adenoma

“…Earlier studies have shown a female dominance in patients with CS, Cushing's disease, and unilateral adrenal adenomas, but a balanced sex ratio in PBMAH patients (2,10,11). PBMAH patients usually present at their 50 to 60 years, often older than those with PPNAD, Cushing's disease, and UAA (1,2,12,13). The time from the first symptoms of PBMAH to the diagnosis can be about 7.8 years (13).…”

“…In Cushing's disease, the bilateral adrenal hyperplasia is ACTH-dependent, and the plasma ACTH levels are elevated. DST is useful in differentiating Cushing's disease and PBMAH (1). Primary aldosteronism and pheochromocytoma can also cause bilateral adrenal hyperplasia but lack the excessive cortisol production, which is distinct from PBMAH.…”

“…Endogenous Cushing's syndrome (CS) is caused by the primary adrenal over-secretion of cortisol in approximately 15-20% of the cases (1). Unilateral adrenal adenomas or carcinomas can explain most adrenal CS.…”

“…However, bilateral lesions handle about 10-15% of adrenal CS. They include primary pigmented nodular adrenocortical disease (PPNAD), primary bilateral macronodular adrenocortical hyperplasia (PBMAH), and rarely bilateral adenomas or carcinomas (1). PBMAH accounts for less than 1% of endogenous CS and is often associated with autonomous cortisol secretion (2).…”

Pregnancy during the course of Cushing’s syndrome: a case report and literature review

“…Hence, physicians face a clinical overlap, in which many features of CS (weight gain, fatigue, edema, hypertension, hyperglycemia, stretch marks, mood changes etc.) can also be attributed to pregnancy (2,3,4). Thus, their coexistence represents a diagnostic challenge.…”