title: Pregnancy does not accelerate corticotroph tumor progression in Nelson's syndrome.
abstract: BACKGROUND
  Pituitary surgery is the first line of treatment for Cushing's disease; when surgery fails, bilateral adrenalectomy may be proposed, particularly for women with a desire for pregnancy. Little is known about the impact of pregnancy on corticotroph tumor progression after bilateral adrenalectomy.
  
  
  OBJECTIVE
  The aim was to evaluate the impact of pregnancy on corticotroph tumor progression after bilateral adrenalectomy in Cushing's disease and to assess maternal and pregnancy outcomes.
  
  
  METHODS
  We conducted a retrospective cohort study.
  
  
  METHODS
  Patients who became pregnant after bilateral adrenalectomy were followed in a single center.
  
  
  METHODS
  Twenty pregnancies from 11 patients with Cushing's disease were treated by bilateral adrenalectomy and no pituitary irradiation.
  
  
  METHODS
  Corticotroph tumor progression was assessed by serial pituitary magnetic resonance imaging and plasma ACTH measurements before, during, and after pregnancy. Comparisons were performed using paired Wilcoxon rank tests. Data on maternal and neonatal outcomes were recorded by correspondence from patients and obstetricians.
  
  
  RESULTS
  Corticotroph tumor progression occurred in eight of 17 pregnancies, and ACTH increased in eight of 10 pregnancies. However, rates of increase during or after pregnancy were not faster than those observed before pregnancy. Maternal complications occurred in four pregnancies from two patients, including gestational hypertension in three and gestational diabetes mellitus in three. Among these four pregnancies, three had a favorable outcome, and one led to an in utero death after eclampsia, due to loss to follow-up. No other maternal or fetal complications were reported.
  
  
  CONCLUSIONS
  Pregnancy does not accelerate corticotroph tumor progression after bilateral adrenalectomy. Pregnancy is manageable, provided the patients can be followed closely.
authors.affiliation: Department of Endocrinology , Hôpital Cochin, Assistance Publique Hôpitaux de Paris, 75014 Paris, France. guillaume.assie@cch.aphp.fr
authors.forename: François R
authors.initials: FR
authors.lastname: Jornayvaz
authors.forename: Guillaume
authors.initials: G
authors.lastname: Assie
authors.forename: Marie
authors.initials: M
authors.lastname: Bienvenu-Perrard
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
authors.forename: Laurence
authors.initials: L
authors.lastname: Guignat
authors.forename: Jérôme
authors.initials: J
authors.lastname: Bertherat
authors.forename: Stéphane
authors.initials: S
authors.lastname: Silvera
authors.forename: Xavier
authors.initials: X
authors.lastname: Bertagna
authors.forename: Paul
authors.initials: P
authors.lastname: Legmann
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000150:complications / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D000236:Adenoma / Q000150:complications / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D000315:Adrenalectomy / Q000534:rehabilitation; D000328:Adult; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009347:Nelson Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D047748:Pituitary ACTH Hypersecretion / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D011247:Pregnancy / Q000502:physiology*; D011252:Pregnancy Complications, Neoplastic / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult