title: Surgical successful treatment of Cushing's syndrome in a pregnant patient complicated with severe cardiac involvement.
abstract: We encountered a case of a pregnant woman with adrenal causes of Cushing's syndrome who exhibited congestive heart failure as an initial symptom. Since the patient was also a diabetic, we treated her with high levels of diuretics and insulin. Echocardiography revealed a remarkable thickening of the left ventricle without asymmetric hypertrophy. The diagnosis of Cushing's syndrome caused by adrenal adenoma was confirmed by the endocrinological data and magnetic resonance imaging. The right adrenal adenoma was removed in the 28th week of pregnancy. After the operation, her congestive heart failure and hyperglycemia dramatically improved. Five weeks after the operation, she delivered a normal infant by caesarean section without complications. Only 4 months after delivery, the thickening of her left ventricle was normalized. We consider that the progression of her left ventricular hypertrophy induced by the changes in hemodynamic load during pregnancy may have been augmented by the excess of plasma cortisol. Operative therapy may be recommended for pregnant Cushing's syndrome patients with severe hypercortisolism complicating congestive heart failure.
authors.affiliation: Third Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kamiya
authors.forename: M
authors.initials: M
authors.lastname: Okada
authors.forename: A
authors.initials: A
authors.lastname: Yoneyama
authors.forename: Y
authors.initials: Y
authors.lastname: Jin-no
authors.forename: T
authors.initials: T
authors.lastname: Hibino
authors.forename: O
authors.initials: O
authors.lastname: Watanabe
authors.forename: S
authors.initials: S
authors.lastname: Kajiura
authors.forename: Y
authors.initials: Y
authors.lastname: Suzuki
authors.forename: H
authors.initials: H
authors.lastname: Iwata
authors.forename: S
authors.initials: S
authors.lastname: Kobayashi
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000601:surgery; D000315:Adrenalectomy; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002316:Cardiotonic Agents; D002940:Circadian Rhythm; D003480:Cushing Syndrome / Q000150:complications* / Q000601:surgery*; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery*; D011254:Pregnancy in Diabetics / Q000188:drug therapy
chemical_list: D000959:Antihypertensive Agents; D002316:Cardiotonic Agents; D004232:Diuretics; D007004:Hypoglycemic Agents; D007328:Insulin; D004077:Digoxin; D005665:Furosemide; D004298:Dopamine; D006854:Hydrocortisone