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

García, Rosario Martínez; Martínez-Pérez, Aleix; Pozo, Carlos Domingo del; Ferrer, RL

doi:10.1007/s40618-015-0345-0

Cited by 19 publications

(9 citation statements)

References 6 publications

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“…In women who develop severe CD while pregnant, the first option to consider is surgery (pituitary adenomectomy or laparoscopic adrenalectomy) (273). In a systematic review of pregnancies in women diagnosed with CS, 61 underwent surgery at a gestational age of 21 (range 17-26) weeks.…”

Section: Rationalementioning

confidence: 99%

ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy

Luger

Broersen

Biermasz

et al. 2021

European Journal of Endocrinology

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Pregnancies are rare in women with pituitary adenomas, which may relate to hormone excess from secretory subtypes such as prolactinomas or corticotroph adenomas. Decreased fertility may also result from pituitary hormone deficiencies due to compression of the gland by large tumours and/or surgical or radiation treatment of the lesion. Counselling premenopausal women with pituitary adenomas about their chance of conceiving spontaneously or with assisted reproductive technology, and the optimal pre-conception treatment, should start at the time of initial diagnosis. The normal physiological changes during pregnancy need to be considered when interpreting endocrine tests in women with pituitary adenomas. Dose adjustments in hormone substitution therapies may be needed across the trimesters. When medical therapy is used for pituitary hormone excess, consideration should be given to the known efficacy and safety data specific to pregnant women for each therapeutic option. In healthy women, pituitary gland size increases during pregnancy. Since some pituitary adenomas also enlarge during pregnancy, there is a risk of visual impairment, especially in women with macroadenomas or tumours near the optic chiasm. Pituitary apoplexy represents a rare acute complication of adenomas requiring surveillance, with surgical intervention needed in some cases. This guideline describes the choice and timing of diagnostic tests and treatments from the pre-conception stage until after delivery, taking into account adenoma size, location and endocrine activity. In most cases, pregnant women with pituitary adenomas should be managed by a multidisciplinary team in a centre specialised in the treatment of such tumours.

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Section: Rationalementioning

confidence: 99%

ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy

Luger

Broersen

Biermasz

et al. 2021

European Journal of Endocrinology

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show abstract

“…Some case reports showed the possibility of surgery during the third trimester, with a higher risk of prematurity (6,8,9). For instance, laparoscopic adrenalectomy for CS in pregnancy was found to be a safe and efficacious procedure up to 32 weeks of gestation (30), leading to a reduction in perinatal mortality and maternal morbidity rates, but with little effect on the occurrence of preterm birth and intrauterine growth restriction (30,31). There are very limited data on the efficacy and the risks induced by bilateral adrenalectomy for hypercortisolism during pregnancy: if this option is chosen, the ideal time frame is the same as for unilateral adrenalectomy.…”

Section: What Are the Risks For The Fetus?mentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Management of Cushing’s syndrome during pregnancy: solved and unsolved questions

Brue

Amodru

Castinetti

2018

European Journal of Endocrinology

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With fewer than 200 reported cases, Cushing's syndrome (CS) in pregnancy remains a diagnostic and therapeutic challenge. In normal pregnancies, misleading signs may be observed such as striae or hypokalemia, while plasma cortisol and urinary free cortisol may rise up to 2- to 3-fold. While the dexamethasone suppression test is difficult to use, reference values for salivary cortisol appear valid. Apart from gestational hypertension, differential diagnosis includes pheochromocytoma and primary aldosteronism. The predominant cause is adrenal adenoma (sometimes without decreased ACTH), rather than Cushing's disease. There are considerable imaging pitfalls in Cushing's disease. Aberrant receptors may, in rare cases, lead to increased cortisol production during pregnancy in response to HCG, LHRH, glucagon, vasopressin or after a meal. Adrenocortical carcinoma (ACC) is rare and has poor prognosis. Active CS during pregnancy is associated with a high rate of maternal complications: hypertension or preeclampsia, diabetes, fractures; more rarely, cardiac failure, psychiatric disorders, infection and maternal death. Increased fetal morbidity includes prematurity, intrauterine growth retardation and less prevalently stillbirth, spontaneous abortion, intrauterine death and hypoadrenalism. Therapy is also challenging. Milder cases can be managed conservatively by controlling comorbidities. Pituitary or adrenal surgery should ideally be performed during the second trimester and patients should then be treated for adrenal insufficiency. Experience with anticortisolic drugs is limited. Metyrapone was found to allow control of hypercortisolism, with a risk of worsening hypertension. Cabergoline may be an alternative option. The use of other drugs is not advised because of potential teratogenicity and/or lack of information. Non-hormonal (mechanical) contraception is recommended until sustained biological remission is obtained.

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“…Although laparoscopic adrenalectomy in pregnant patients has been performed for Cushing syndrome, hyperaldosteronism and pheochromocytoma,11–14 this is the first case of robotic-assisted adrenal mass excision reported in the literature for an indication other than pheochromocytoma and paraganglioma 15 16. There are multiple publications since 2007 that demonstrate the safety and utility of robotic-assisted abdominal surgical procedures in pregnant patients 13 17–21.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted left adrenal cystic mass excision in a pregnant patient

et al. 2022

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A symptomatic adrenal mass diagnosed during pregnancy is a rare clinical scenario. Two primary considerations are the timing of intervention and determining the appropriate surgical approach. Here, we present the case of a young female patient with flank pain, whom on diagnostic imaging, was found to have a large cystic adrenal mass. She was taken for a robotic-assisted resection of her left-sided adrenal mass during the second trimester of pregnancy. Preoperative and postoperative assessment demonstrated a viable intrauterine pregnancy. She tolerated the procedure well and was discharged 5 days later with resolution of her symptoms on follow-up. As one of only three reported cases of robotic adrenal surgery during pregnancy, we demonstrate that a robotic-assisted surgical approach is a viable and durable surgical option under the given clinical circumstances.

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

Cited by 19 publications

References 6 publications

ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy

ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy

MANAGEMENT OF ENDOCRINE DISEASE: Management of Cushing’s syndrome during pregnancy: solved and unsolved questions

Robotic-assisted left adrenal cystic mass excision in a pregnant patient

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