Abstract: Cushings syndrome (CS) during pregnancy is a rare condition with fewer an 200 cases reported in the literature, However, because CS results in increased fetal and maternal complications, its early diagnosis and treatment are critical. During pregnancy, 40-50% of cases are caused by adrenal adenomas, while Cushings disease (CD) accounts for only one third of the cases. We describe here 3 patients with CD who needed to be treated during pregnancy.
CASE 1: A 25-year old woman had the diagnosis of CD confirmed in April 2010. Four months later, she was submitted to a transsphenoidal surgery (TSS) which failed. The patient was given ketoconazole and reached UFC normalization at a dose of 800 mg/day. Two years later, she became pregnant and ketoconazole was wihdrawn. However, due to progressive increase in UFC, blood pressure and blood glucose levels, ketoconazole was re-started at 20 weeks of gestation, which resulted in hormonal and clinical control. The patient gave birth to a healthy male newborn at 38 weeks of gestation, APGAR 9/9.
CASE 2: A 30-year old woman had the diagnosis of CD confirmed in October 2012. Two months later, she was submitted to an unsuccessful TSS. The patient was treated with ketoconazole, reaching UFC normalization at a dose of 800 mg daily. Forteen months later, she became pregnant and ketoconazole was withdrawn. However, due to worsening of clinical status with increase of blood pressure and blood glucose, ketoconazole was re-started at 20 weeks of gestation (600 mg/day), which enabled transient hormonal, biochemical and clinical control. However, due to progressive increase of UFC, cabergoline was added at the 30th week, leading to hormonal normalization at the dose of 2 mg/week. The patient gave birth to a female newborn at 37 weeks of gestation, weighing 2850 g, 48 cm in length, Apgar 9/9, no congenital abnormalities, and normal female genitalia.
CASE 3: CD was confirmed at 30th week of gestation in a 27-year old woman who presented with excessive weight gain, easy bruising and hypertension. The CD diagnosis was based on the elevation of both UFC and midnight salivary cortisol (MNSV), plasma ACTH of 44.5 pg/ml and a 1.2 cm pituitary adenoma depicted on MRI scan. The patient was given CAB, reaching UFC normalization and improvement of clinical status at the dose of 3 mg/week. The patient was submitted to a successful TSS 3 months after the delivery of a healthy male newborn.
18 - 21 May 2019
European Society of Endocrinology