Cushing's syndrome in pregnancy

Abstract

A 22-year-old G(1)P(0) was admitted at 26 weeks gestation for preeclampsia, hyperglycaemia and cushingoid features. Elevated 24-h urine free cortisol (UFC) and suppressed plasma adrenocorticotrophic hormone (ACTH) suggested ACTH-independent Cushing's syndrome. Ultrasound showed left adrenal mass. She delivered preterm at 28 weeks due to severe preeclampsia and fetal distress. The infant expired after 4 days. Blood pressure was controlled after delivery and the patient was discharged on ketoconazole. Adrenalectomy was planned postpartum; however, she withdrew consent and was lost to follow-up. A 33-year-old G(1)P(1) presented with gestational diabetes. Pregnancy was complicated by premature delivery at 31 weeks for fetal distress. The baby improved and survived. Three months postpartum, she was evaluated for osteoporosis after sustaining a fracture from a fall. Cushingoid facies, elevated 24-h UFC, suppressed ACTH and a right adrenal mass on MRI confirmed an ACTH-independent Cushing's syndrome. She underwent adrenalectomy and improved.

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

“…Since then, at least 166 pregnancies have been reported involving 149 patients as individual cases and small case series [8,9,[11][12][13][14]16,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. The etiology of CS in pregnant women is different from that in general population.…”

“…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].…”

Cushing’s syndrome diagnosed after delivery: a case report

“…However, medical treatment turned out to be rather ineffective and potentially hazardous. When it comes to surgical treatment, recorded experience shows that operative intervention just after diagnosis is the most satisfactory [32,33].…”

Padronização dos valores de referência de cortisol salivar noturno em gestantes: comparação com os valores de mulheres não grávidas e pacientes com doença de Cushing

“…Desta forma, assim como em mulheres não grávidas, o cortisol sérico, geralmente, não estabelece o diagnóstico da SC durante a gestação. (Vilar et al, 2007;Holgado-Galicia et al, 2011).…”

“…Em casos relatados por outros autores, também foi usada a combinação do HDDST e RM para o diagnóstico da DC (Triay et al, 2010). Outros relatos de caso da literatura mostraram pacientes com aumento do UFC, não supressão do cortisol com dose baixa de DMS, como já esperado pela própria gestação, e valores baixos de ACTH, que levaram à realização de imagem adrenal, sendo confirmado SC de causa adrenal (Shaw et al, 2002;Doshi et al, 2003;Kita et al, 2007;Holgado-Galicia et al, 2011;Borna et al, 2012;Chang et al;Lim et al, 2013). Sammour et al reportaram um caso em que a paciente após suspeita clínica apresentava aumento do UFC, não supressão do cortisol por dose baixa de DMS e aumento do cortisol salivar.…”