Pregnancy and Cushing's syndrome: example of endocrine interaction.
Pregnancy rarely occurs in women with Cushing's syndrome, and when it does, fetal mortality and morbidity are very high. We describe a 30-year-old woman who was found to have severe Cushing's syndrome in the 22nd week of her first pregnancy, after a year of unsuccessful attempts to conceive. The patient had the majority of the symptoms and signs characteristic of the syndrome. Laboratory examinations revealed hypokalemia of 2.7 mEq/l, serum cortisol 39.5 micrograms/dl without diurnal variation, free urinary cortisol 1,850 to 3,500 micrograms/24 h, 17-hydroxycorticosteroids (OHCS) 52.5 mg/24 h, 17-ketosteroids (KS) 12 mg/24 h, and ACTH 29 pg/ml. No suppression was observed upon dexamethasone administration (2 and 8 mg). Ultrasound examination of the adrenal glands revealed a left adrenal tumor with a diameter of 4.2 cm. An adrenocortical adenoma was successfully excised in the 24th week of pregnancy. During the 37th week of pregnancy, she delivered a normal baby girl. Postoperatively, the patient was put on maintenance therapy. One year after delivery, mother and child are in perfect health.
Barasch
E
E
Department of Medicine C, Rokach (Hadassah) Hospital, Tel Aviv, Israel.
Sztern
M
M
Spinrad
S
S
Chayen
R
R
Servadio
C
C
Kaufman
H
H
Ben Bassat
M
M
Blum
I
I
D000236:Adenoma / Q000150:complications / Q000601:surgery; D000305:Adrenal Cortex Hormones / Q000097:blood; D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000601:surgery; D000315:Adrenalectomy; D000328:Adult; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D011263:Pregnancy Trimester, Third; D014463:Ultrasonography
D000305:Adrenal Cortex Hormones