Endocrine Abstracts

Introduction: Pregnancy is rare in patients with Cushing’s syndrome (CS) because of hypercortisolemia, hyperandrogenemia, and/or hyperprolactinemia. Diagnostic tests for CS have become less reliable due to the physiological changes in the hypothalamo-pituitary adrenal (HPA) axis during gestation. Some of these changes may persist until the 5th postpartum week. We report a case of Cushing’s disease (CD) that recurred after pregnanacy.

Case presentation: A 32-year-old woman presented with a facial plethora, and menstrual disturbances that have developed over 1 year. Biochemical testing suggested CD. Pituitary MRI demonstrated a macroadenoma extending to suprasellar cysterna with displacement of infundibulum. Transsphenoidal surgery was performed. Subsequent biochemical tests suggested remission and her pituatry MRI was normal. This picture continued to be the same during 2 years of follow up. Then, she became pregnant. She presented to endocrinology outpatient clinic at 8 months of pregnancy. She had normal weight gain compatible with her gestation. Her blood pressure and glucose profiles results were also normal. A healthy male infant with normal weight was delivered. At 8 weeks postpartum, she developed facial plethora and began to gain weight. At that time 1 mg dexamethasone supression test result was 3.3 μg/dl and the basal urinary free cortisol (UFC) was normal. Since it’s immediate post-partum period, we thought that these results still might be persistence of increased maternal (HPA) activity during pregnancy. At 5 months postpartum, she continued to gain weight and there was elevated UFC and loss of diurnal variation of cortisol. Plasma ACTH level was 41.5 pg/ml. Her pituitary MRI revealed 6.5×3 mm microadenoma surrounding infundibulum suggesting recurrence. Three months later, her blood pressure began to rise. All clinical and biochemical findings have become overt at that time.

Conclusion: In conclusion, this case illustrates CD can recur after pregnancy and hormonal changes observed during pregnancy make the diagnosis more challenging.