Endocrine Abstracts

A 26-year-old-pregnant woman at 22 weeks presented with hypertension (155/94 mmHg), gestational diabetes (GDM), purple striae, and acne on her chest and back. Physical examination showed fat deposits in her interscapular and neck regions, emotional instability, and easy bruising, but without facial rounding or muscle wasting. She was started on Labetalol and Nifedipine for hypertension, and GDM was managed with dietary changes. Initial laboratory results revealed elevated morning serum cortisol of 1100 nmol/l, suppressed ACTH (<3 pg/mL), 24-hour urinary cortisol of 3510 nmol/L-eight times the normal value. At 24 weeks, hydrocortisone day-curve test indicated no diurnal cortisol variation. Dexamethasone suppression tests (DST) with 2 mg and 8 mg doses showed 0% suppression, with cortisol remaining at 1261 nmol/l and 1437 nmol/l, respectively. Plasma metanephrines were normal. MRI adrenal scan identified 3.8 cm heterogeneous left adrenal adenoma After multidisciplinary team consultation, laparoscopic left adrenalectomy performed at 28 weeks’ gestation. Intraoperatively, she received hydrocortisone replacement (20/10/10 mg). Post-surgery, cortisol levels fell to 390 nmol/l, with marked improvements in mood, blood pressure, and glycemic control, negating the need for antihypertensive medication. She experienced steroid withdrawal symptoms and continued hydrocortisone (10/5/5 mg) throughout the pregnancy. Histology confirmed adrenal adenoma. She delivered a healthy baby at 34 weeks + 6 days. Three months post-adrenalectomy, short Synacthen test (SST) showed inadequate adrenal response, with a peak cortisol of 203 nmol/l, necessitating continued hydrocortisone. At six months, SST results remained low, but by ten months, adrenal function improved with a peak cortisol of 552 nmol/l, reaching 609 nmol/l by eleven months, allowing for hydrocortisone discontinuation. Cushing’s syndrome during pregnancy is rare, with 138 reported cases. Pregnancy-induced physiological changes can mimic Cushing’s, complicating diagnosis. Elevated urinary/salivary cortisol and 8 mg DST are valuable for differentiating Cushing’s from pregnancy-related changes.