Endocrine Abstracts

We describe a case of a women with Cushing’s syndrome and bilateral adrenal nodules who presented with symptoms and signs of Cushing’s syndrome that manifested during pregnancy which unfortunately ended in a miscarriage in first trimester. Investigations showed raised urinary cortisols, failure of suppression of cortisol with dexamethasone and suppressed ACTH. CT adrenals showed bilateral macronodular adrenal hyperplasia. Patients’s history suggested she had similar symptoms with her earlier pregnancies which all ended up in miscarriages and resolution of symptoms following miscarriages. History also revealed that since last 2 years she was on ovulation induction treatment (IVF-C human chorionic gonadotropins) and Menotrophin (it contains FSH and LH). Considering that she had a strong history of recurrent symptoms during pregnancy it was highly likely that Cushing syndrome was due to overproduction of adrenal luteinizing hormone/chorionic gonadotropins receptors with pregnancy plus prolong stimulation due to exogenous FSH/lH and human chorionic gonadotropins rather than primary adrenal adenomas. She was commenced on monthly long acting GnRH (Leuprolide) injections. After receiving three dosages there was marked improvement of Cushing’s symptoms and and her urinary cortisol normalised to lower end of normal. By 3rd month she had lost 10 kg of weight, had normal blood pressure and was euglycemic.