Pregnancy after pituitary surgery does not influence the recurrence of Cushing’s disease

Abstract

Purpose: Pregnancy is associated with the activation of the hypothalamus-pituitary-adrenal axis, which can cause a misdiagnosis of Cushing's syndrome. The aim of this study is to evaluate the impact of pregnancy after pituitary surgery on the recurrence rate in Cushing's disease (CD) patients.Methods: This was a retrospective study in a tertiary center. Between 1990 and 2020, 355 CD patients underwent pituitary surgery. Of those included, 113 female patients who were ≤ 45 years old (median age of 32 years, 14-45), PS remission, a follow up of ≥ 6 months (median of 122 months, 6-402) and an available obstetric history. Recurrence was de ned as the diagnosis of Cushing's syndrome via at least two altered rst-line methods. The patients were divided into two subgroups according to pregnancy: no pregnancy or pregnancy prior to CD diagnosis (NP/PP) and pregnancy after CD pituitary surgery (PA).Results: Overall, recurrence occurred in 43 out of 113 patients (38%). A higher recurrence rate was seen in the PA subgroup (11/22, 50%), but there was no signi cant difference between the NP/PP subgroup (32/91, 35%). No difference in survival-free recurrence (SFR) was found between NP/PP and PA subgroups. The lower SFR was related to a higher PS plasma ACTH and normal pituitary at pathological analyses.Conclusions: There was no difference in the recurrence rate in patients according to pregnancy history.Other studies with higher numbers of patients are needed to con rm these data.