title: Cushing's syndrome and pregnancy: aetiologies and prognosis in twenty-two patients.
abstract: 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.
authors.affiliation: Clinique des Maladies Endocriniennes et Métaboliques, Hôpital Cochin, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Guilhaume
authors.forename: M L
authors.initials: ML
authors.lastname: Sanson
authors.forename: L
authors.initials: L
authors.lastname: Billaud
authors.forename: X
authors.initials: X
authors.lastname: Bertagna
authors.forename: M H
authors.initials: MH
authors.lastname: Laudat
authors.forename: J P
authors.initials: JP
authors.lastname: Luton
mesh_terms: 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
chemical_list: D000324:Adrenocorticotropic Hormone