Successful Management of Cushing's Disease During Pregnancy by Transsphenoidal Adenectomy

Abstract

Pregnancy in patients with Cushing's syndrome is rare. It is associated with a high fetal loss, increased frequency of preterm labour and excessive maternal morbidity. We describe a patient who became pregnant while investigations for hypertension were being done. Cushing's disease was diagnosed and the patient had transsphenoidal pituitary surgery at 22 weeks gestation. To our knowledge this is the first time this operation has been done during pregnancy for this condition. Cushing's disease was controlled, but because of worsening hypertension, she had a caesarean section at 30 weeks gestation. Subsequently her blood pressure fell and her hydrocortisone replacement therapy is being withdrawn. Her daughter is now thriving after initial problems with pneumothoraces.

Cirugía transesfenoidal en enfermedad de Cushing durante gestación: Report of one case

“…Sólo 40% de los embarazos llegan a término en pacientes portadoras de síndrome de Cushing. El 35% termina prematuramente y 20% termina en aborto [6][7][8][9][10] .…”

“…El tratamiento de la enfermedad de Cushing durante el embarazo incluye la observación expectante, la administración de ciproheptadina, la irradiación de hipófisis, la adrenalectomía bilateral y la cirugía transesfenoidal 8 . Se han publicado previamente 4 pacientes tratados con cirugía transesfenoidal 8,11,13 , recomendándose esta técni-ca como tratamiento de primera línea.…”

“…Se han publicado previamente 4 pacientes tratados con cirugía transesfenoidal 8,11,13 , recomendándose esta técni-ca como tratamiento de primera línea.…”

Pregnancy and pituitary disorders

“…Pregnancy may influence the course of CS in different ways, either exacerbating or ameliorating the disease (76,79,80,91,92). Unregulated placental CRH may be the cause of exacerbating hypercortisolemia during pregnancy, and it improves after parturition.…”

“…Early diagnosis and treatment of the disease are important to improve the outcome of both the fetus and the mother. Treatment of choice for ACTH-secreting adenomas is transsphenoidal surgery, which has been performed successfully during the second trimester of pregnancy (28, 88,92,94). Radiotherapy is normally contraindicated during gestation, but pregnancy shortly after treatment by gamma-knife for CD with normal gestational course, despite high disease activity, is reported (95).…”