Endocrine Abstracts

Introduction: Cushing’s disease (CD) is reported in 60-70% of all patients with Cushing’s syndrome (CS), but occurs only in approximately 33% of the reported CS cases in pregnancy. Nevertheless, despite its rarity, pregnancy in patients with CS can be troublesome because of the risk of maternal-fetal complications.

Observation: A 28-year-old female patient was referred to our endocrinology department for a suspected CS with morphological alterations and recent diagnosed diabetes mellitus. The clinical, laboratory, and imaging findings were compatible with CD and a secondary hypogonadotropic hypogonadism due to pituitary macroadenoma of 17 mm. The patient underwent transsphenoidal resection of the adenoma. No complications arose during the operative and postoperative period. The anatomopathological study disclosed a corticotroph-cell adenoma. Postoperatively, the patient had normal adrenalism. Five and seventeen months after the surgery, respectively, she had two pregnancies with successful maternal-fetal outcomes. The patient remained in remission with no clinical symptoms of CS. Biochemical workup after 5 years and 10 months was as follows: 24 h UFC 150 µg; ACTH 156 pg/ml and serum cortisol measured at 0800 h. after 1 mg dexamethasone administration at midnight 20 ng/ml. Pituitary MRI revealed an adenoma remnant invading the cavernous sinus. Thus, recurrent CD was confirmed. Just a month later, the patient got pregnant. She is now in her first trimester. After a thorough discussion of the risks and benefits to both her and the baby, she elected to proceed with no medical nor surgical treatment.

Conclusion: Pregnancy in women with a diagnosis of CD is an extremely rare event and its diagnosis and treatment are a real medical challenge. The impact of achieving biochemical remission on fetal outcomes is unknown.