Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
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Cushing syndrome in pregnancy, diagnosed after delivery

  • Kim, Han Byul (Division of Endocrinology and Metabolism, Department of Internal Medicine, Raphael Hospital) ;
  • Kim, Mi Kyung (Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University Dongsan Hospital) ;
  • Kim, El (Department of Neurosurgery, Keimyung University Dongsan Hospital) ;
  • Ahn, Keun Soo (Department of Surgery, Keimyung University Dongsan Hospital) ;
  • Kim, Hye Soon (Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University Dongsan Hospital) ;
  • Kim, Nam Kyung (Park Kyung Dae Clinic of Internal Medicine)
  • Received : 2020.04.21
  • Accepted : 2020.05.12
  • Published : 2021.01.31
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Abstract

Cushing syndrome (CS) is rare in pregnancy, and few cases have been reported to date. Women with untreated CS rarely become pregnant because of the ovulatory dysfunction induced by hypercortisolism. It is difficult to diagnose CS in pregnancy because of its very low incidence, the overlap between the clinical signs of hypercortisolism and the physiological changes that occur during pregnancy and the changes in hypothalamus-pituitary-adrenal axis activity that occur during pregnancy and limit the value of standard diagnostic testing. However, CS in pregnancy is associated with poor maternal and fetal outcomes; therefore, its early diagnosis and treatment are important. Here, we report two patients with CS that was not diagnosed during pregnancy, in whom maternal and fetal morbidity developed because of hypercortisolism.

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References

  1. Lado-Abeal J, Rodriguez-Arnao J, Newell-Price JD, Perry LA, Grossman AB, Besser GM, et al. Menstrual abnormalities in women with Cushing's disease are correlated with hypercortisolemia rather than raised circulating androgen levels. JClin Endocrinol Metab 1998;83:3083-8.
  2. Lindsay JR, Jonklaas J, Oldfield EH, Nieman LK. Cushing's syndrome during pregnancy: personal experience and review of the literature. J Clin Endocrinol Metab 2005;90:3077-83. https://doi.org/10.1210/jc.2004-2361
  3. Caimari F, Valassi E, Garbayo P, Steffensen C, Santos A, Corcoy R, et al. Cushing's syndrome and pregnancy outcomes: a systematic review of published cases. Endocrine 2017;55:555-63. https://doi.org/10.1007/s12020-016-1117-0
  4. Polli N, Pecori Giraldi F, Cavagnini F. Cushing's syndrome in pregnancy. J Endocrinol Invest 2003;26:1045-50. https://doi.org/10.1007/BF03348206
  5. Aron DC, Schnall AM, Sheeler LR. Cushing's syndrome and pregnancy. Am J Obstet Gynecol 1990;162:244-52. https://doi.org/10.1016/0002-9378(90)90859-6
  6. Andreescu CE, Alwani RA, Hofland J, Looijenga LH, de Herder WW, Hofland LJ, et al. Adrenal Cushing's syndrome during pregnancy. Eur J Endocrinol 2017;177:K13-20. https://doi.org/10.1530/EJE-17-0263
  7. Brue T, Amodru V, Castinetti F. Management of endocrine disease. Management of Cushing's syndrome during pregnancy: solved and unsolved questions. Eur J Endocrinol 2018;178: R259-66. https://doi.org/10.1530/EJE-17-1058
  8. Lindsay JR, Nieman LK. The hypothalamic-pituitary-adrenal axis in pregnancy: challenges in disease detection and treatment. Endocr Rev 2005;26:775-99. https://doi.org/10.1210/er.2004-0025
  9. Lopes LM, Francisco RP, Galletta MA, Bronstein MD. Determination of nighttime salivary cortisol during pregnancy: comparison with values in non-pregnancy and Cushing's disease. Pituitary 2016;19:30-8. https://doi.org/10.1007/s11102-015-0680-3
  10. Sammour RN, Saiegh L, Matter I, Gonen R, Shechner C, Cohen M, et al. Adrenalectomy for adrenocortical adenoma causing Cushing's syndrome in pregnancy: a case report and review of literature. Eur J Obstet Gynecol Reprod Biol 2012;165:1-7. https://doi.org/10.1016/j.ejogrb.2012.05.030