Endocrine Abstracts

Hormone-secreting adrenal tumours are rare occurrences in women or reproductive age. The commonest is phaeochromocytoma, followed by primary aldosteronism and Cushing’s syndrome. The shared maternal phenotypic feature of these tumours in marked hypertension. They may be difficult to diagnose as many of the clinical features are mimicked by pregnancy, e.g. flushing, weight gain, palpitations. Furthermore hypertensive disease occurs in approximately 5% of pregnant women. However, there are specific clinical features associated with each tumour type that aid diagnosis; the hypertension in phaeochromocytoma may be paroxysmal; primary aldosteronism is often accompanied by hypokalaemia and the striae in Cushing’s syndrome are usually more purple and marked than in normal pregnancy. It is important to know the normal ranges for the specific endocrine tests used to diagnose each hormone-producing tumour, and once a diagnosis has been made a multidisciplinary team should be involved with clinical management. This should include endocrinologists with an understanding of gestational disease, obstetricians, specialist anaesthetists, midwives and neonatologists. Individualised decisions should be made with regard to treatment with surgery or drugs. All hormone-secreting adrenal tumours are associated with increased rates of adverse pregnancy outcome, including preterm labour and stillbirth. This talk will summarise current knowledge about the management of these rare, and potentially life-threatening tumours in pregnant women and will consider the merits of prospective population cohorts to improve our understanding of the optimal management strategies to improve maternal and offspring outcomes.