Cushing syndrome and pregnancy: a single tertiary center experience

B. Gonul Iremli*^a (Dr), SH. Oguz^a (Prof), SN. Sendur^a (Prof), S. Dagdelen^a (Prof), T. Erbas^a (Prof)

^a Hacettepe University Medical School, Ankara, TURKEY

* burcingnl@yahoo.com

Cushing’s syndrome and pregnancy: a single tertiary center experience

Burcin Gonul Iremli¹, Seda Hanife Oguz¹, Suleyman Nahit Sendur¹, Selcuk Dagdelen¹, Tomris Erbas¹

¹Hacettepe University School of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey.

Introduction: Due to negative effects of hypercortisolism over reproductive cycle, it is extremely rare for a pregnancy to occur in Cushing’s Syndrome (CS). In our study, we aim to investigate the clinical specifics in subjects diagnosed with CS while pregnancy.

Observations: We examined our CS cases which are registered in Hacettepe University medical database retrospectively. We investigated three cases with CS while pregnancy in regard of their clinical features, diagnosis and follow-up processes and responses to medical therapy.

Case 1: A 33-year-old and 10 weeks pregnant patient was consulted from perinatology clinic to our department with preeclampsia. It is understood that the patient has had symptoms associated with CS before pregnancy and worsened during pregnancy. Laboratory results showed ACTH-dependent hypercortisolemia. After the termination of pregnancy, IPSS and transsphenoidal surgery was performed. A 4-mm corticotroph adenoma was reported. After three years, the patient is in remission.

Case 2: A 25-year-old patient was admitted at 24th week of her pregnancy, due to symptoms of purple striae on abdomen, weight gain, hyperglycemia and hypertension. It was considered to be a case of CS. She delivered a healthy infant at 38th week via caesarean section. Post-delivery laboratory results showed ACTH-dependent hypercortisolemia. A 4-mm adenoma was excised after confirmation of central gradient via IPSS. Pathology confirmed an ACTH-secreting adenoma. The patient is in second year of remission.

Case 3: A 34-year-old patient at 10^th week of her pregnancy had swelling in lower extremities and was hypertensive. With a diagnosis of HELLP syndrome, pregnancy was terminated. Her laboratory results were consistent with ACTH-independent hypercortisolemia. The patient is in fourth year of remission after left adrenalectomy for the 4 cm adenoma.

Discussion: It’s hard to differentiate CS in pregnancy because of physiological changes which developed with pregnancy. Clinical findings in CS can imitate disorders, which are typical to pregnancy such as preeclampsia or HELLP syndrome.

The author has declared no conflict of interest.