BES2005 Poster Presentations Clinical (51 abstracts)
Cushing's syndrome in pregnancy: a case report
SPL Rice 1 , H Lane 1 , R Chudleigh 1 , O Gibby 2 , D Scott-Coombes 1 , JS Davies 1 , MF Scanlon 1 & DA Rees 1
1Departments of Medicine and Surgery, University Hospital of Wales, Cardiff, UK; 2Department of Diabetes and Endocrinology, Royal Gwent Hospital, Newport, Wales, UK.
The association between Cushing's syndrome and pregnancy is uncommon due to associated sub-fertility. Recognising this is important, as there implications for both mother and foetus.
A twenty year old presented at twenty three weeks gestation. Insulin requiring diabetes had developed as had oedema. Pigmented abdominal striae were prominent. Her serum sodium concentration was noted to be low (3 mmol/l). 24 hour urinary free cortisol was elevated (>1380 nmol/24 hrs) with failure to suppress with 1mg overnight dexamethasone (1289nmol/l). Abdominal MRI showed a 4cm right sided adrenal mass. Laparoscopic adrenalectomy was performed at 30 weeks gestation. Good resolution of abdominal wounds was seen post-operatively. Oedema and glycaemic control improved. Histology showed a 40mm by 40mm by 20mm adenoma that was well circumscribed within the adrenal gland without any evidence of mitotic activity. At 38 weeks gestation a healthy male infant was delivered.
Cushing's syndrome in pregnancy has substantial foetal and maternal complications. Premature delivery is particularly prevalent. In one reported series of 22 cases, 16 were born before 37 weeks. Maternal complications include hypertension, diabetes, pre-eclampsia, poor wound healing and greater infection rate. Management options include surgical intervention, the use of cortisol synthesis disrupters
(ketoconazole, metyrapone), or the employment of a watch and wait strategy, deferring definitive treatment until after delivery.
Treatment needs to be tailored to each individual case but a pro-active management approach including appropriate imagery and surgery is desirable if circumstances allow. Modern laparoscopic surgical techniques now enable definitive treatment to be offered into the third trimester and should therefore be considered.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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