Cushing’s syndrome in pregnancy: a case report and mini review of the literature

Abstract

Adrenal diseases in pregnant women are diagnosed relatively rarely. The main cause of hypercortisolemia during pregnancy is Cushing's syndrome related to adrenal adenoma. It is important to diagnose Cushing's syndrome in pregnant women because it can lead to significant maternal and foetal complications and morbidity. However, due to physiological endocrine changes and symptoms in pregnant women the diagnosis of this disorder can be a challenge. One current case describes a 38-year-old pregnant woman with hypertension, oedema and an adrenal tumour. At the beginning, Conn syndrome was suspected, but after careful analysis Cushing's syndrome (with an adenoma of the right adrenal gland) was diagnosed. After delivery and 5 weeks of pharmacological treatment the patient underwent right side adrenalectomy by laparoscopy.

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

“…Whatever the type of surgery (pituitary or adrenal), it should be ideally performed during the second trimester, before the 24th week of gestation (29). 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).…”

“…The management of CS during pregnancy is indeed highly challenging both for diagnosis, due to technical caveats or to the possibility of pregnancyinduced CS (5) and for therapy due to limited information on drug safety. This topic has previously been reviewed in recent years by Bronstein and colleagues (6) and by others (7,8,9,10). We will thus, in this present review, summarize in the form of a number of open questions, the main challenges clinicians face when managing a woman with CS who is pregnant or seeking to become pregnant.…”

Cushing’s Syndrome Complicating Pregnancy

“…So far, with fewer than 150 cases of Cushing syndrome in pregnancy have been reported in the literature. When Cushing syndrome occurs during pregnancy, it may be difficult to detect clinically because of the central weight gain, abdominal striae, increased blood pressure, and glucose intolerance associated with normal pregnancy [1][2][3][4][5][6][7][8]. Pregnancy dramatically affects the hypothalomo-pituitary-adrenal (HPA) axis and the endogenous secretion of cortisol, with total and free serum cortisol concentrations reaching levels higher than those compared to nonpregnant controls.…”

Acupuncture treatment for insulin sensitivity of women with polycystic ovary syndrome and insulin resistance: a study protocol for a randomized controlled trial

“…It is characterized by chronic anovulation and hyperandrogenism and is often accompanied by obesity and insulin resistance (IR) as IR is present in nearly 40% of PCOS [1]. In addition, IR, hyperinsulinemia, and dyslipidemia worsen with aging, and the risk of miscarriage is three times higher than in healthy women [2]. They are also at an increased risk of pregnancy complications such as impaired glucose tolerance, gestational diabetes mellitus, pregnancy-induced hypertension and preeclampsia, and small for gestational age children [2].…”

“…In addition, IR, hyperinsulinemia, and dyslipidemia worsen with aging, and the risk of miscarriage is three times higher than in healthy women [2]. They are also at an increased risk of pregnancy complications such as impaired glucose tolerance, gestational diabetes mellitus, pregnancy-induced hypertension and preeclampsia, and small for gestational age children [2]. It may affect general health and the quality of life.…”