Endocrine Abstracts

Background: Cushing’s disease is a condition rarely encountered during pregnancy. It is known that hypercortisolism is associated with increased maternal and foetal morbidity and mortality.

Aims and methods: A comprehensive search of the literature was performed for cases of Cushing’s disease in pregnancy including our own case. Analysis was performed of all pregnant patients with Cushing’s disease who were treated with surgery compared to a surrogate control group of pregnant patients with untreated Cushing’s syndrome. Foetal outcomes were compared including preterm labour, intrauterine growth retardation, intrauterine foetal death, and neonatal death. Cases of Cushing’s disease who were not in remission or with missing post-operative data were mentioned but excluded from our statistical analysis.

Results: There were 11 previously reported cases of Cushing’s disease surgically managed between the 10th and 23rd weeks of pregnancy. Of those, three cases were excluded due to lack of post-operative biochemical results or follow-up information and one case was excluded due to lack of biochemical remission. Foetal complications occurred as follows: preterm labour 29% (2/7), intrauterine growth retardation 29% (2/7), neonatal death 14% (1/7), and intrauterine foetal death 0% (0/7). Of these, there was a significant reduction (P=0.04) in preterm labour when compared to the preterm labour rates occurring in untreated Cushing’s syndrome. Other foetal complications were not statistically different. Out of the 11 case reports, maternal and surgical complications included pre-eclampsia (n=4), syndrome of inappropriate antidiuretic hormone (n=2), diabetes insipidus (n=1), cerebrospinal fluid leak (n=1). Three patients did not have any maternal or surgical complications.

Conclusions: Transsphenoidal surgery for Cushing’s disease can be performed safely during the second trimester of pregnancy. The rate of preterm labour is significantly lowered when Cushing’s disease is surgically treated and biochemical remission is achieved during pregnancy.