Endocrine Abstracts

Introduction: Adrenal Cushing’s syndrome during pregnancy is rare, and few cases have been reported. It is infrequent to identify pregnant women with adenomas that have cortisol and androgen co-secretion. The diagnosis and treatment of excess cortisol during pregnancy is challenging when the patient does not want a pregnancy interruption.

Case Report: 38-year-old woman with arterial hypertension for four years. During her working days, she remained upright constantly and presented back pain. As part of the approach to this pain, they requested a simple chest tomography without evidence of alterations in the thoracic spine or mediastinum, but with the incidental finding of a 35-mm right adrenal lesion, for which they requested a contrasted abdominal tomography with an adrenal gland protocol. Due to administrative delays, she could not have a timely evaluation of endocrinology. At the time of the initial evaluation, she attended at 14 weeks of gestation, a high-risk pregnancy due to advanced maternal age and pre-pregnancy hypertension. When evaluating this adrenal lesion, hypercortisolism was confirmed by two results with more than 2 to 3 times the reference value of free cortisol in 24-hour urine and adrenocorticotropic hormone less than 5 pg/ml, in addition, hyperandrogenism of adrenal origin with elevated values of 17 hydroxyprogesterone (1633 ng/dl VR: 10-120 ng/dl) and total testosterone (242 ng/dl VR: 0-50 ng/dl), excess aldosterone and catecholamines were ruled out. Pharmacological treatments for Cushing’s syndrome are contraindicated during pregnancy, and the patient rejected the possibility of voluntarily terminating the pregnancy; she decided to undergo resection by oncological surgery. At 22 weeks of gestation, she had a 3.5×3.0×2.5 cm adrenal adenoma resected laparoscopically without complications with subsequent remission of hypercortisolism and hyperandrogenism. Oral prednisolone was started due to adrenal insufficiency due to the slowdown in the activity of the left adrenal gland. The 38-week pregnancy was terminated by cesarean section with a healthy female neonate. The evolution was good in the follow-up one month and three months after the end of the pregnancy. However, she continued with oral corticosteroid replacement requirements and is under surveillance, awaiting a possible recovery of the hypothalamic-pituitary-adrenal axis.

Conclusion: Adrenal adenomas identified during pregnancy are a challenge, drugs are a contraindication in this scenario, and surgical resection can be performed when there is a qualified interdisciplinary team.