Endocrine Abstracts

Introduction: Cushing’s syndrome can impair the gonadotrophic axis in women of child bearing age if left untreated. Furthermore undergoing endoscopic transphenoidal surgery can render patients hypogonadal, thereby reducing the chances of spontaneous conception. In such cases, pregnancy is usually achieved by assisted contraceptive techniques. We present a case of spontaneous pregnancy following transphenoidal surgery and bilateral adrenalectomy.

Case: A 28 year old lady was referred to the joint antenatal endocrine clinic at 13 weeks gestation. She was initially diagnosed with Cushing’s disease three years prior and underwent transphenoidal resection of a 5mm right sided pituitary tumour. Biochemically she went into remission for approximately 12 months however she suffered a recurrence of Cushing’s syndrome and subsequently underwent laparoscopic bilateral adrenalectomy. Post operatively there was evidence of complete cure with unrecordable cortisol levels. She was maintained on a daily dose of hydrocortisone, fludrocortisone and levothyroxine. Following her operation she experienced somewhat irregular but heavy periods and spontaneously became pregnant 15 months thereafter. Through the course of her pregnancy, her dose of hydrocortisone, fludrocortisone levothyroxine were increased. She did suffer mild adrenal crises at eight weeks and 34 weeks gestation. She developed Gestational diabetes at 26 weeks and was managed with metformin and insulin. From the obstetric point of view, there were no major concerns regarding foetal growth. At 37 weeks gestation she underwent induction, receiving Betamethasone prior, to aid foetal lung maturation. She delivered a healthy male infant via caesarean section and was managed with intrapartum intravenous hydrocortisone.

Conclusions: The patient reverted to her original medication post partum and no complications were experienced during the intra and postpartum period. The patient was unable to breastfeed following delivery due to lack of milk expression. Our case adds to the limited number of patients who have achieved spontaneous pregnancy following transphenoidal surgery for pituitary disease.