[Cushing's syndrome during pregnancy].
The rare association of Cushing's syndrome and pregnancy is explained by the amenorrhea and sterility inherent to the syndrome. In the literature, 125 cases have been reported: 30 cases of early diagnosis and 95 others diagnosed in the second half of pregnancy.
When hypercorticism exists before pregnancy it is hardly secretory. Its diagnosis, at an early stage, is not hindered by the hormone modifications of pregnancy. Its aetiological treatment raises the problem of the compatibility in pursuing the latter.
The positive and aetiological diagnoses of Cushing's syndrome are difficult and its prevalence may therefore be underestimated. The evocative clinical signs are unspecific: excessive weight gain, hypertension of pregnancy and gestational diabetes. The 24-hour free hypercortisoluria and the absence of dexamethasone inhibition are of little diagnostic value after the 14th week of amenorrhea. The positive diagnosis therefore relies essentially on the abolition of the circadian rhythm of cortisol. The biological hyperandrogenia commonly observed is not discriminating. Adrenal aetiologies are frequent. Imaging must be performed to eliminate an adrenocortical tumor.


CONCLUSIONS
The maternal prognosis depends on the hypertension, preeclampsia, diabetes and the complications of Cushing's syndrome. It depends on the activity of the hypercorticism and its early aetiological treatment, which must not be delayed after pregnancy. The foetal prognosis depends on the maternal prognosis. It is represented by preterm delivery, hypotrophy and death of the foetus in utero. The therapeutic management must be symptomatic and aetiologic, maternal and obstetrical.
Lubin
Vanessa
V
Service d'endocrinologie et nutrition et maladies métaboliques, Hôpital Saint-Louis, 1, avenue Claude Vellefaux, 75010 Paris. vanessa.lubin@free.fr
Gautier
Jean-François
JF
Antoine
Jean-Marie
JM
Beressi
Jean-Paul
JP
Vexiau
Patrick
P
D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000175:diagnosis; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000963:Antimetabolites / Q000627:therapeutic use; D003480:Cushing Syndrome / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D005315:Fetal Diseases / Q000209:etiology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007231:Infant, Newborn; D018311:Luteoma / Q000097:blood / Q000175:diagnosis; D008797:Metyrapone / Q000627:therapeutic use; D007752:Obstetric Labor, Premature / Q000209:etiology; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D011379:Prognosis; D012307:Risk Factors; D013739:Testosterone / Q000097:blood
D000893:Anti-Inflammatory Agents; D000963:Antimetabolites; D013739:Testosterone; D003907:Dexamethasone; D006854:Hydrocortisone; D008797:Metyrapone