Endocrine Abstracts

Background: Cushing’s syndrome is a rare condition in pregnancy, because infertility is one of the main features of this pathology. Association between pregnancy and cortisol excess involves a high rate of mortality and morbidity for mother and fetus. Hypertension, preeclampsia, diabetes, miscarriage, preterm delivery or sudden intrauterine death can occur. We describe a case of a pregnancy in a patient with a history of Cushing’s Syndrome, diagnosed during the previous pregnancy.

Case presentation: A 31 years old patient was diagnosed in 2018 with Cushing’s syndrome, during the 19th week of pregnancy. Clinical examination revealed weakness, inspiratory dyspnea, high blood pressure, lower limbs bilateral edema, truncal obesity, moon facies, hirsutism, buffalo hump, purple striae; the paraclinical investigations revealed a right adrenal adenoma (30/35/28 mm) on MRI, proteinuria (0,1 g/l/24 hours), hypoalbuminemia (2,4 g/dl), hypokalemia (2,9 mmol/l). Blood pressure ranged between 160-180/100-120 mmHg despite therapy. Hormonal analyses performed confirmed the diagnosis of adrenocorticotropic hormone (ACTH-) independent CS. The obstetrical ultrasound showed a single, live fetus. The patient’s condition deteriorated, developing severe preeclampsia with multiple complications, and a medical board took the decision to terminate the pregnancy for mother’s interest. Three weeks later, she underwent laparoscopical right adrenalectomy followed by hydrocortisone replacement.

Results: Evolution was favourable. Her current status in January 2020 reveals regression of all cushingoid features; blood pressure was 110/60 mmHg. Hormonal analyses revealed a normal level for morning serum cortisol (5.74 mg/dl). At the moment, the patient is 26 weeks pregnant, with a good evolution, a single, live fetus, with normal growth and anatomy, according to gestational age and a normal placenta. Her clinical and paraclinical profiles are closely monitored.

Discussion: The serum cortisol increases normally during pregnancy and the screening for Cushing’s syndrome is more difficult, particularly in the second and third trimester. The management for such cases is complex and sometimes difficult, especially when a termination of pregnancy is necessary due to severe complication. It requires multdiciplinary approach, with quickly implemented measures. Fertility and overall wellness of the patient could and should be fully reobtained, like in this case.

Conclusion: Pregnancy in a patient with Cushing syndrome induces multiple complications, requiring sometimes termination of pregnancy for mother’s interest. Surgical treatment of Cushing syndrome restores the fertility and allows a normal evolution of upcoming pregnancies for such patients.

Keywords: Cushing’s syndrome, pregnancy, preeclampsia, laparoscopical adrenalectomy, fertility.