Cushing's syndrome and pregnancy: aetiologies and prognosis in twenty-two patients.
OBJECTIVE
The association of an active Cushing's syndrome and pregnancy is a rare event which raises specific diagnostic difficulties and bears poor maternal and foetal prognoses. We report our series of 22 patients.


METHODS
Age range was 19-34 (mean +/- SEM = 27.3 +/- 1.5) the onset of hypercorticism occurred before the pregnancy (n = 2), during the pregnancy (n = 15) or in the early post-partum (n = 5). The diagnosis was made during the pregnancy of 4 patients and in the post-partum of 18.


RESULTS
Cushing's syndrome was revealed by the local manifestations of an adrenocortical tumour in 3 patients and by the clinical features of hypercorticism in 19 patients: mainly morphological changes (n = 19), high blood pressure (n = 12), and/or accelerated hair growth (n = 7). Aetiological distribution was noteworthy by the unusual predominance of primary adrenocortical tumours (n = 16) especially adrenocortical carcinomas (n = 8). Cushing's disease was present in only 4 patients and in 2 an ectopic ACTH secretion was observed. This association implied a high rate of complications for the mother: high blood pressure (n = 12), diabetes (n = 3), preeclampsy (n = 3) and pulmonary embolism (n = 1) and for the infant: prematurity (n = 16), hypotrophy (n = 4), adrenal insufficiency (n = 1), virilization (n = 1), stillbirth (n = 1). During their pregnancy 18 patients had a symptomatic treatment while only 4 patients (3 with adrenocortical carcinoma and one with an ACTH-secreting phaeochromocytoma) had a unilateral adrenalectomy.


CONCLUSIONS
This condition is difficult to recognize: the diagnosis of Cushing's syndrome may be obscured by normal hormonal modifications of the pregnant state; it also forbears particular severity because of maternal and foetal complications, the unusual prevalence of malignant tumours and the particular difficulty in curing or merely controlling the hypercorticism.
Guilhaume
B
B
Clinique des Maladies Endocriniennes et Métaboliques, Hôpital Cochin, Paris, France.
Sanson
M L
ML
Billaud
L
L
Bertagna
X
X
Laudat
M H
MH
Luton
J P
JP
D000306:Adrenal Cortex Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D018246:Adrenocortical Adenoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D018268:Adrenocortical Carcinoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D003480:Cushing Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010673:Pheochromocytoma / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism / Q000601:surgery; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis* / Q000628:therapy; D011256:Pregnancy Outcome; D011379:Prognosis
D000324:Adrenocorticotropic Hormone