Cushing's syndrome (CS) is a rare disease caused by a chronic excess of cortisol. Hypercortisolaemia may affect reproductive system leading to infertility in women. However, some of the patients remain fertile, although pregnancy is uncommon. In our report, we describe the case of a 31-years old woman suffering from hypertension, oligomenorrhea, easy bruising, muscle weakness and elevated levels of cortisol. During hospitalization, high level of serum cortisol with stiff diurnal rhythm and undetectable plasma ACTH concentration were found. The overnight 1 mg dexamethasone (DEX) suppression test and the test with 8 mg of DEX were performed - plasma cortisol levels after both doses of DEX were over expected values. Thus, the diagnosis of ACTH independent hypercortisolaemia was established. After three weeks of ketoconazole treatment, high level of β-HCG was found corresponding to the third week of pregnancy. The ketoconazole was shift to metyrapone but afterwards ketoconazole was added again. The treatment was well tolerated and pregnancy proceeded without complications. US scan revealed a 2 cm adenoma of the left adrenal gland, confirmed by CT. An adrenalectomy was performed. Concluding, we think that medical treatment of CS in pregnant women is well tolerated and safe both for the mother and fetus.
Several data suggest that the endocrine and immune systems are closely interconnected, therefore, we investigated the effect of interleukin-1 on adrenocortical regeneration. The study was performed on adult rats subjected to left adrenal enucleation combined with contralateral adrenalectomy. The animals were given purified human recombinant IL-1 alpha (5 micrograms/kg), IL-1 beta (5 micrograms/kg) anti-human IL-1 receptor antibody (10 micrograms/kg) and combination of interleukins and antibodies. The cell proliferation measured by bromodeoxyuridine incorporation and plasma corticosterone determined by a RIA kit were evaluated six days after operation. The mean cell growth ratio expressed as number of BrdU-positive cells per 1,000 cells was 11.86 +/- 0.45 in the control group. IL-1b significantly stimulated the proliferation ratio (15.30 +/- 0.88; p < 0.01) and this effect could be prevented by addition of IL-1rAb. The antibody caused also a well-marked inhibition of cell growth ratio (8.23 +/- 0.67; p < 0.01). The plasma corticosterone concentration was higher in IL-1b-treated animals than in the control group, 107.79 +/- 2.82 vs. 61.08 +/- 2.0 ng/ml, respectively, p < 0.01. On the other hand, IL-1rAb decreased corticosterone secretion (31.53 +/- 2.58 ng/ml, p < 0.01) and reversed the stimulatory effect of of IL-1b. In contrast, IL-1a seemed to have no influence on adrenocortical regeneration. In conclusion, this study supported the thesis of close interconnection between immune and endocrine systems and revealed that IL-1b could act as a growth-promoting factor on regenerating adrenal cortex in the rat.
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