Endocrine Abstracts

Introduction: Cushing’s syndrome (CS) is a condition characterized by chronic exposure to excess glucocorticoids, mostly due to adrenocorticotropic hormone (ACTH) excess, but in 10–15% due to ACTH-independent cortisol excess. Although CS directly or indirectly affects most organ systems, there can often be a significant diagnostic delay, especially during pregnancy.

Case presentation: Twenty-nine-year-old woman complaining about pain in her lower back, high blood pressure, swelling of lower extremities and nausea was admitted because of newly discovered mass of right adrenal gland. She had a C-section 5 months before admission in her 32nd week of pregnancy because of preeclampsia and diabetes. The patient has had diabetes since her 2nd month of pregnancy and has been using slow-acting insulin ever since. She was diagnosed with hypertension during pregnancy, with high blood pressure even after delivery. One month after delivery, patient started experiencing pain in thoracolumbar spine, X-ray showed fractures of L3 and L4 vertebrae. Computed tomography and magnetic resonance imaging showed reduced bone mineral density, multiple compressive fractures of thoracolumbar spine, and a heterodense right adrenal mass, 47×25 mm in diameter. During physical exam, moon face and purple stretch marks on her lower abdomen and thighs were seen. Endocrinological examination revealed elevated basal cortisol without circadian rhythm, and low ACTH. Overnight dexamethasone suppression test, low-dose and high-dose dexamethasone suppression tests were without cortisol suppression. After preoperative preparation, right-sided adrenalectomy was performed. Glycemic profiles and HbA1c after surgery were normal and antidiabetic therapy was stopped. She also remained normotensive with normal cortisol, ACTH, and electrolyte status. Pathohistological examination confirmed adrenal adenoma.

Conclusion: The diagnosis of CS in pregnancy is often delayed because symptoms overlap with the changes associated with a normal pregnancy. Increased awareness of CS, especially during pregnancy, is necessary, as CS can affect maternal and fetal outcomes.