title: Course of pregnancies in women with Cushing's disease treated by gamma-knife.
abstract: Data concerning pregnancy in women with Cushing's disease treated by gamma-knife (GK) are scanty. We present and discuss the course and outcome of five pregnancies in two women with Cushing's disease (CD), the first of whom was treated only by GK, and the second one treated by surgery, GK and ketoconazole. In the first patient, pregnancy was uneventful and full-term. During gestation, plasma ACTH, serum cortisol and 24-h urinary free cortisol (UFC) levels were steady, and always in the normal range for healthy non-pregnant individuals. The newborn was healthy and normal-weight. In the second woman, two pregnancies, occurring 3 years after GK and few months after ketoconazole withdrawal, were interrupted by spontaneous abortion or placental disruption despite normal cortisol levels. This patient became again pregnant 3 years later and delivered vaginally a healthy full-term infant. Seven months after the delivery, the patient became pregnant again and at the 39th week of gestation delivered vaginally a healthy male. Hypoprolactinemia and/or central hypothyroidism occurred in both cases. In women with CD treated by GK, pregnancy can occur. However, pregnancy is at risk even when ACTH and cortisol levels are normalized by treatment. After GK, evaluation of pituitary function is mandatory due to the risk of hypopituitarism.
authors.affiliation: Department of Medicine and Pharmacology, Section of Endocrinology, University of Messina, Messina, Italy. ferrau1@interfree.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Ferraù
authors.forename: Marco
authors.initials: M
authors.lastname: Losa
authors.forename: Oana Ruxandra
authors.initials: OR
authors.lastname: Cotta
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Torre
authors.forename: Marta
authors.initials: M
authors.lastname: Ragonese
authors.forename: Francesco
authors.initials: F
authors.lastname: Trimarchi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cannavò
mesh_terms: D058888:14-alpha Demethylase Inhibitors / Q000627:therapeutic use; D000022:Abortion, Spontaneous / Q000209:etiology; D000037:Abruptio Placentae / Q000209:etiology; D000328:Adult; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D007037:Hypothyroidism / Q000209:etiology; D007654:Ketoconazole / Q000627:therapeutic use; D047748:Pituitary ACTH Hypersecretion / Q000601:surgery*; D010902:Pituitary Gland / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D011388:Prolactin / Q000097:blood; D016634:Radiosurgery / Q000009:adverse effects*; D047929:Term Birth; D055815:Young Adult
chemical_list: D058888:14-alpha Demethylase Inhibitors; D011388:Prolactin; D007654:Ketoconazole