Successful outcome of pregnancy in a patient with Cushing's disease under treatment with ketoconazole during the first trimester of gestation

Boronat, Mauro; Marrero, D.; López-Plasencia, Yaiza; Barber, M.A.; Schamann, Yaiza; Nóvoa, Francisco J.

doi:10.3109/09513590.2010.521268

Cited by 39 publications

(23 citation statements)

References 11 publications

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“…Women on medical therapy for CS may also become pregnant or women may relapse during pregnancy (124,125). Medical or surgical treatment has complications but so does uncontrolled hypercortisolism, and treatment should be individualised, taking into account the gestational age of the pregnancy.…”

Section: Pregnancymentioning

confidence: 99%

“…Amado et al (136) reported the use of KTZ in the 3rd trimester in a 36-year-old woman with CS due to an adrenocortical adenoma; doses up to 600 mg daily were given between 32 and 37-week gestation of a female foetus, resulting in a significant reduction in UFC and no maternal or neonatal complications. There have been reports of uncomplicated pregnancies and live births of healthy male babies in women who were treated with KTZ at conception and throughout the first trimester (124,125).…”

Section: Pregnancymentioning

confidence: 99%

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THERAPY OF ENDOCRINE DISEASE: Steroidogenesis enzyme inhibitors in Cushing's syndrome

Daniel

Newell‐Price

2015

European Journal of Endocrinology

111

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Steroidogenesis enzyme inhibitors are the mainstay of medical therapy in Cushing's syndrome (CS). Ketoconazole (KTZ) and metyrapone are the most commonly used agents. Although there is considerable experience of their use in individual specialist centres, these drugs have not been rigorously tested in prospective clinical trials. Clinicians face uncertainties and concerns with respect to the safety profile of these agents, and best means to monitor effect. We review steroidogenesis inhibitors in the management of CS, including older agents (KTZ, metyrapone, etomidate and mitotane) and those currently under development (LCI699, non-racemic KTZ), and offer a practical approach for their use in clinical practice.

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Section: Pregnancymentioning

confidence: 99%

Section: Pregnancymentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Steroidogenesis enzyme inhibitors in Cushing's syndrome

Daniel

Newell‐Price

2015

European Journal of Endocrinology

111

View full text Add to dashboard Cite

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“…Although it crosses the placental membrane in animal studies, no neonatal abnormalities have been reported in human patients (28,29). Ketoconazole, the steroidogenesis inhibitor used most often in non-pregnant CS patients, has been utilized less during pregnancy because of its potential side effects, which include an anti-androgenic effect and teratogenicity (only shown in animal studies) (17,30,31). Other adrenal steroidogenesis blockers, such as aminoglutethimide and mitotane, were rarely used, because they were contraindicated as a result of fetal masculinization and teratogenicity respectively (16).…”

Section: Treatment Of Pregnancies With Csmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Management of pregnant patients with Cushing's syndrome

Bronstein¹,

Machado²,

Fragoso³

2015

European Journal of Endocrinology

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Progress in the diagnosis and treatment of endocrine diseases has turned pregnancy into a possibility for women with such medical disorders, including Cushing's syndrome (CS). Nevertheless, despite its rarity, pregnancy in patients with CS can be troublesome because of the risk of maternal-fetal complications. Therefore, hypercortisolism, if present, should be surgically or medically controlled in most cases. Moreover, changes in the hypothalamic-pituitary-adrenal axis during normal pregnancy may mislead the diagnosis of CS during this period, because many laboratory assessments suggestive of CS may be present in normal pregnancy, with clinical features mimicking those seen in patients with CS. The aim of the present review is to update the diagnostic approach to this medical condition, mainly for pregnant women without previous diagnosis of CS, and to describe the therapeutic strategies for CS during pregnancy in order to minimize complications for both mother and fetus.

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“…In two of the four cases ketoconazole was used during the first trimester of pregnancy. [7][8][9][10] In the rat, ketoconazole crosses the placenta and is teratogenic, and in humans it is classified as FDA category C. A recent population-based case-control study did not find a higher rate of congenital abnormalities in infants born to mothers who had received oral ketoconazole treatment during pregnancy; however, the number of exposed cases and controls was too small to allow for solid conclusions. 11 Moreover, ketoconazole has antiandrogenic effects through inhibition of aromatase activity.…”

Section: Discussionmentioning

confidence: 99%

Cabergoline treatment for recurrent Cushing’s disease during pregnancy

Nakhleh

Saiegh

Reut

et al. 2016

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ObJECTIvE: Cushing`s disease during pregnancy is associated with an increased risk for maternal and fetal complications. In recurrent Cushing`s disease following transsphenoidal surgery, and when re-operation is not feasible, medical treatment is usually considered. Cabergoline was found to be effective in reducing hypercortisolism in Cushing's disease. Evolving data concerning the safety of cabergoline use during pregnancy show no significant increase in the rate of complications during pregnancy or the postnatal period. mEThODS: We report a 29-year-old woman, gravida 0, para 0, with recurrent Cushing`s disease, three years after transsphenoidal resection of pituitary aCTh-secreting macroadenoma. Repeated mRI revealed an empty sella with a small gadolinium-enhancing lesion, suspected to be an adenoma remnant on the medial wall of the right cavernous sinus. as the patient was not willing to undergo repeat surgical intervention, treatment with cabergoline was initiated, with a gradual dose titration up to 3.5 mg/week. Clinical improvement ensued, and 4 months later, she conceived spontaneously. after discussing treatment options with the patient, cabergoline treatment at a dose of 2 mg/week was continued throughout pregnancy. RESUlTS: The patient showed complete clinical remission during pregnancy. Consecutive tests of 24-h urinary free cortisol concentration were not found to be elevated. pregnancy and delivery were uneventful except for mild hypothyroidism observed during the second trimester. at full term the patient delivered a healthy female infant, by an elective cesarean section. CONClUSION: This case report demonstrates that cabergoline may be an effective and safe therapeutic option for the treatment of Cushing's disease during pregnancy.Key words: Cabergoline, Cushing's disease, Pregnancy HORMONES 2016, 15(3):453-458 Address for correspondence: Dr. Afif Nakhleh, Endocrinology Department, Bnai Zion Medical Center, 47 Golomb St, Haifa 31048, Israel; Tel.: +972-4-8359931, E-mail: anakhleh@yahoo.com Received: 18-03-2016, Accepted: 26-05-2016 Case report CaSE REpORTA 29 year-old woman, gravida, 0 para 0, was referred to our outpatient clinic with a 3-year history of oligomenorrhea, unexplained weight gain of 20

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Successful outcome of pregnancy in a patient with Cushing's disease under treatment with ketoconazole during the first trimester of gestation

Cited by 39 publications

References 11 publications

THERAPY OF ENDOCRINE DISEASE: Steroidogenesis enzyme inhibitors in Cushing's syndrome

THERAPY OF ENDOCRINE DISEASE: Steroidogenesis enzyme inhibitors in Cushing's syndrome

MANAGEMENT OF ENDOCRINE DISEASE: Management of pregnant patients with Cushing's syndrome

Cabergoline treatment for recurrent Cushing’s disease during pregnancy

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