Cushing’s syndrome in pregnancy caused by an adrenal adenoma


Authors: Koudelková Zuzana 1;  Gerychová Romana 2;  Nešporová Tereza 3
Authors‘ workplace: Gynekologicko-porodnické oddělení, Nemocnice Třebíč, p. o. 1;  Gynekologicko-porodnická klinika LF MU a FN Brno 2;  Interní gastroenterologická klinika LF MU a FN Brno 3
Published in: Ceska Gynekol 2021; 86(5): 331-334
Category: Case Report
doi: 10.48095/cccg2021331

Overview

Objective: The description of a rare case of Cushing’s syndrome caused by an adrenal adenoma in pregnancy with successful treatment. Case presentation: 30-ear-old Gravida 3 female was admitted to our hospital with hypertension at the 18th week of gestation. Hormonal analyses revealed primary Cushing’s syndrome with high plasma cortisol levels and low levels of adrenocorticotropic hormone. Magnetic resonance imaging demonstrated a mass on the right-side of the adrenal gland. Adrenalectomy was performed in the 28th week of gestation and the following histopathology revealed an adrenocortical adenoma. Pregnancy continued until the 38th week of gestation with glucocorticoid replacement therapy and the patient gave birth vaginally to a healthy boy in the 38th week of gestation. Conclusion: Cushing’s syndrome in pregnancy rarely occurs; dia­gnosis may be dismissed or determined after birth in most cases. Misdia­gnosis of Cushing’s syndrome is common because of physiological increase of corticotropin hormones and cortisol levels and overlapping symptoms that can occur even during physiological pregnancy. Cushing’s syndrome should have a place in the differential dia­gnosis of hypertension in pregnancy (especially before the 20th week of gestation). Analysis of the urinary free cortisol level and circadian rhythm blood cortisol can provide a reasonable strategy to dia­gnose Cushing’s syndrome in pregnant women. Early dia­gnosis and surgical treatment can significantly reduce maternal and fetal complications.

Keywords:

hypertension – adenoma – pregnancy – Cushing’s syndrome


Sources

1. Kršek M. Cushingův syndrom. Interní Med 2013; 15 (11–12): 368–371.

2. Hunt AB, McConahay WM. Pregnancy associated with diseases of the adrenal glands. Am J Obstet Gynecol 1953; 66 (5): 970–987. doi: 10.1016/s0002-9378 (16) 38611-2.

3. Zhang X, Liao H, Zhu X et al. A successful pregnancy in a patient with secondary hypertension caused by adrenal adenoma: a case report. BMC Pregnancy Childbirth 2019; 19 (1): 116. doi: 10.1186/s12884-019-2262-2.

4. Lindsay JR, Nieman LK. The hypothalamic-pituitary-adrenal axis in pregnancy: challenges in disease detection and treatment. Endocr Rev 2005; 26 (6): 775–799. doi: 10.1210/er.2004-0025.

5. Bronstein MD, Machado MC, Fragoso MC. Management of endocrine disease: management of pregnant patients with Cushing’s syndrome. Eur J Endocrinol 2015; 173 (2): R85–R91. doi: 10.1530/EJE-14-1130.

6. Caimari F, Valassi E, Garbayo P et al. Cushing‘s syndrome and pregnancy outcomes: a systematic review of published cases. Endocrine 2017; 55 (2): 555–563. doi: 10.1007/s12020-016-1117-0.

7. Vlk R, Procházka M. Hypertenzní onemocnění v těhotenství. Ceska Gynekol 2018; 83 (2): 145–154.

8. Andreescu CE, Alwani RA, Hofland J et al. Adrenal Cushing’s syndrome during pregnancy. Eur J Endocrinol 2017; 177 (5): K13–K20. doi: 10.1530/EJE-17-0263.

9. Lin W, Huang HB, Wen JP et al. Approach to Cushing’s syndrome in pregnancy: two cases of Cushing’s syndrome in pregnancy and a review of the literature. Ann Transl Med 2019; 7 (18): 490. doi: 10.21037/atm.2019.07.94.

10. Diri H, Bayram F, Simsek Y et al. A pregnant woman who underwent laparoscopic adrenalectomy due to Cushing’s syndrome. Case Rep Endocrinol 2014; 2014: 283458. doi: 10.1155/2014/283458.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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Czech Gynaecology

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2021 Issue 5

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