Endocrine Abstracts

Background: Pregnancy occurs rarely in Cushing’s syndrome (CS), slightly over 150 cases have been reported in the literature. The risk of maternal morbidity and a poor fetal outcome is significant when CS coexists with pregnancy. CS may be difficult to detect clinically and laboratory because of the hormonal changes and pathological comorbidities associated with normal pregnancy.

Material and methods: A case of CS that was diagnosed and treated during pregnancy.

Case: Woman Y., 30y.o., since she was 18 had menstrual irregularities and since she was 28 an arterial hypertension, type 2 DM. She was on supervision of therapeutist and take metformin for her DM and hypotensive medication. Unexpected pregnancy occurs in December 2016. She was referred in our clinic in 15 weeks of her pregnancy because of uncontrolled DM and hypertension. Examination revealed increased blood pressure, fatigue, easy bruising, excessive hair growth on the face and body, swelling and rounding of the face, edema of legs and feet. Laboratory evaluation: UFC-1475.0 and 1511.0 nmol/24 h (N 138.0–524.4), serum cortisol – at 0800 h −868 nmol/l (190–650), at 2300 h −995 nmol/l (50–350)), suppressed ACTH level. HbA1c–7.7%. Insulin therapy initiated to treat DM. MRI data: adenoma in left adrenal (32×30 mm). 13.05.16.-unilateral adrenalectomy was done. Adrenal insufficiency developed postoperatively and glucocorticoid therapy was started. She was under close supervision of gynecologist. At 38 weeks gestation surgical delivery performed (boy, 1900 g, 44 cm, 7/8 Apgar score, with three degrees of fetal growth retardation and two degrees of malnutrition). Insulin was cancelled after delivery, and hydrocortisone and antihypertensive therapy cancelled 2 months postpartum.

Conclusion: High clinical suspicion of the CS during pregnancy can help for the diagnosis and leads to better outcomes for the mother and the fetus. Multidisciplinary approach needs for these patients with careful supervision during pregnancy and postpartum.