Pregnancy-associated Cushing’s disease? An exploratory retrospective study

Abstract

In this exploratory study, over one quarter of women of reproductive age with CD appeared to have symptomatic disease onset within 1 year of childbirth. This relatively high rate of pregnancy-associated CD suggests a possible causal relationship related to the stress of pregnancy and pituitary corticotroph hyperactivity in the peripartum period. This possible association suggests a heightened degree of clinical suspicion and biochemical testing for CD may be warranted after childbirth. Further study of this possible link between pregnancy and CD is warranted.

Desmopressin Stimulation Test in a Pregnant Patient with Cushing's Disease

“…1,12 Almost 40% of pituitary microadenomas in CD were invisible or poorly visible in non-contrast MRI, in which contrast-enhanced MRI detected them. 13 In the case series from Lindsay et al, the non-contrast MRI could not correctly identify pituitary adenomas in 38% of pregnant patients with available data. 1 The same case series reported a pregnant patient having normal pituitary MRI and was later surgically confirmed as having CD from a 3x3 adenoma with positive staining for ACTH.…”

Persistent vs Recurrent Cushing’s Disease Diagnosed Four Weeks Postpartum

“…The symptoms and signs of Cushing's syndrome overlap with those seen in normal pregnancy, making diagnosis of Cushing's disease during pregnancy challenging [ 1 ]. Potential mechanisms of gestational hypercortisolemia include increased systemic cortisol resistance during pregnancy, decreased sensitivity of plasma ACTH to negative feedback causing an altered pituitary ACTH setpoint, and noncircadian secretion of placental CRH during pregnancy causing stimulation of the maternal HPA axis [ 5 ]. Consequently, both urinary excretion of cortisol and late-night salivary cortisol undergo a gradual increase during normal pregnancy, beginning at the 11 th week of gestation [ 2 ].…”

The Incidence of Pregnancy-Associated Cushing's Disease and Its Relation to Pregnancy: A Retrospective Study

“…(1) The first group comprised women with pregnancy-associated CD (n = 19). Pregnancy-associated CD was defined as CD onset potentially related to pregnancy, namely, during gestation or within 12 months after delivery or abortion, and other predisposing factors were excluded according to their own questionnaire feedback (12). The pregnancies of the women in this group all occurred within 12 months prior to disease onset.…”

“…Frontiers in Endocrinology | www.frontiersin.org period (12). Placental production of corticotropin-releasing hormone (CRH), hypersensitization of corticotrophs to CRH, and desensitization to negative feedback by cortisol contribute to the surge of maternal plasma ACTH and cortisol levels.…”

“…In contrast to the confirmed relationship between reproductive hormone changes and hypercortisolism mentioned above, the association between pregnancy and CD has not been extensively studied. In a retrospective study, Palejwala et al (12) observed that 26.8% of women (n = 11) of reproductive age with CD developed CD during gestation or <12 months following pregnancy; this was defined as pregnancy-associated CD. They proposed a hypothesis that an overloading dose of cortisol from an overactivated hypothalamic-pituitary-adrenal axis during pregnancy could promote tumorigenesis or stimulate a subclinical ACTHdependent adenoma.…”