Yeungnam Univ J Med.  2021 Jan;38(1):60-64. 10.12701/yujm.2020.00290.

Cushing syndrome in pregnancy, diagnosed after delivery

Affiliations
  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Raphael Hospital, Daegu, Korea
  • 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
  • 3Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
  • 4Department of Surgery, Keimyung University Dongsan Hospital, Daegu, Korea
  • 5Park Kyung Dae Clinic of Internal Medicine, Gyeongju, Korea

Abstract

Cushing syndrome (CS) is rare in pregnancy, and few cases have been reported to date. Women with untreated CS rarely become pregnant because of the ovulatory dysfunction induced by hypercortisolism. It is difficult to diagnose CS in pregnancy because of its very low incidence, the overlap between the clinical signs of hypercortisolism and the physiological changes that occur during pregnancy and the changes in hypothalamus-pituitary-adrenal axis activity that occur during pregnancy and limit the value of standard diagnostic testing. However, CS in pregnancy is associated with poor maternal and fetal outcomes; therefore, its early diagnosis and treatment are important. Here, we report two patients with CS that was not diagnosed during pregnancy, in whom maternal and fetal morbidity developed because of hypercortisolism.

Keyword

Complication; Cushing syndrome; Hypercortisolism; Pregnancy

Figure

  • Fig. 1. (A) Abdominal computed tomography reveals a 35×28 mm, hypoattenuating mass (arrow) in the right adrenal gland. (B) The excised right adrenal gland shows a well circumscribed, yellowish mass.

  • Fig. 2. (A) Pituitary magnetic resonance imaging shows a 3×4×6 mm, hypointense nodule (arrow) in the left side of the pituitary gland. (B) The intraoperative photograph shows a grayish pink nodule (arrow) in the left side of the pituitary gland.


Reference

References

1. Lado-Abeal J, Rodriguez-Arnao J, Newell-Price JD, Perry LA, Grossman AB, Besser GM, et al. Menstrual abnormalities in women with Cushing's disease are correlated with hypercortisolemia rather than raised circulating androgen levels. J Clin Endocrinol Metab. 1998; 83:3083–8.
Article
2. Lindsay JR, Jonklaas J, Oldfield EH, Nieman LK. Cushing's syndrome during pregnancy: personal experience and review of the literature. J Clin Endocrinol Metab. 2005; 90:3077–83.
Article
3. Caimari F, Valassi E, Garbayo P, Steffensen C, Santos A, Corcoy R, et al. Cushing's syndrome and pregnancy outcomes: a systematic review of published cases. Endocrine. 2017; 55:555–63.
Article
4. Polli N, Pecori Giraldi F, Cavagnini F. Cushing's syndrome in pregnancy. J Endocrinol Invest. 2003; 26:1045–50.
Article
5. Aron DC, Schnall AM, Sheeler LR. Cushing's syndrome and pregnancy. Am J Obstet Gynecol. 1990; 162:244–52.
Article
6. Andreescu CE, Alwani RA, Hofland J, Looijenga LH, de Herder WW, Hofland LJ, et al. Adrenal Cushing's syndrome during pregnancy. Eur J Endocrinol. 2017; 177:K13–20.
Article
7. Brue T, Amodru V, Castinetti F. Management of endocrine disease. Management of Cushing's syndrome during pregnancy: solved and unsolved questions. Eur J Endocrinol. 2018; 178:R259–66.
Article
8. Lindsay JR, Nieman LK. The hypothalamic-pituitary-adrenal axis in pregnancy: challenges in disease detection and treatment. Endocr Rev. 2005; 26:775–99.
Article
9. Lopes LM, Francisco RP, Galletta MA, Bronstein MD. Determination of nighttime salivary cortisol during pregnancy: comparison with values in non-pregnancy and Cushing's disease. Pituitary. 2016; 19:30–8.
Article
10. Sammour RN, Saiegh L, Matter I, Gonen R, Shechner C, Cohen M, et al. Adrenalectomy for adrenocortical adenoma causing Cushing's syndrome in pregnancy: a case report and review of literature. Eur J Obstet Gynecol Reprod Biol. 2012; 165:1–7.
Article
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