Pregnancy-induced Cushing's syndrome in multiple pregnancies.

Leuprolide Acetate Therapy in Luteinizing Hormone–Dependent Cushing's Syndrome

“…27 The bilateral nature of the adrenal hyperplasia in our patient suggests that abnormal tissue-specific expression of the luteinizing hormone and chorionic gonadotropin receptor and the 5-HT 4 receptor occurred during embryogenesis, but the syndrome became clinically evident only after sustained increases in endogenous secretion of the two gonadotropins either during the pregnancies or after menopause. Transient corticotropin-independent Cushing's syndrome during pregnancy with resolution after delivery has been described previously in women with adrenal adenomas 28 and women with mild bilateral adrenal hyperplasia 29,30 ; in one case, the administration of cho-rionic gonadotropin increased urinary 17-hydroxycorticosteroid excretion. 31 The identification of ectopic adrenal receptors could eventually lead to diverse drug treatments as alternatives to adrenalectomy for patients with adrenal Cushing's syndrome.…”

THERAPY OF ENDOCRINE DISEASE: Steroidogenesis enzyme inhibitors in Cushing's syndrome

“…Hypercortisolaemia can interfere with the secretion of gonadotrophins causing anovulation and amenorrhoea (119,120), and hyperandrogonaemia may interfere with implantation. There are very few case reports of women who developed hypercortisolaemia and were diagnosed during pregnancy; biochemical diagnosis is challenging due to the physiological hormonal changes and lack of clearly defined pregnancy reference ranges (121,122,123).…”

“…There are concerns that metyrapone may affect the biosynthesis of steroids in the placenta; however, several case reports describe its use in the first (127,128,129), second (123,127,129,130,131,132) and third trimesters (123,126,129,130,133,134). Metyrapone is generally well tolerated and doses up to 3 g have been used to control hypercortisolaemia (123,130).…”

Cushing’s syndrome in pregnancy

“…This may be due to misdiagnosis before pregnancy or to the presence of a pregnancy-associated stimulatory factor(s) such as products of the feto-placental unit. There are a few reports of recurrent Cushing's syndrome in pregnancy spontaneously remitted after delivery [9,10]. The theory is that several placental peptides, such as CRF, placental ACTH or a no yet defined factor, stimulate the adrenals.…”

“…Although the ideal timing for adrenalectomy during pregnancy is still a matter of debate, the end of the first trimester and the first half of the second trimester are considered the best time for surgery [18,19]. Concerning medical therapy, metyrapone has been used most Hypercortisolism in pregnancy 103 often without evidence of teratogenic effects [9,16]. Moreover, this drug may exacerbate hypertension and favor progression to preeclampsia, which may limit its use [20].…”