Adrenalectomy for adrenocortical adenoma causing Cushing's syndrome in pregnancy: a case report and review of literature.
We present a case of adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome diagnosed in a patient in the third trimester of her pregnancy, with an adrenal mass observed on imaging studies. Laparoscopic adrenalectomy was performed successfully at 32 weeks. To the best of our knowledge, this is the latest gestational age at which laparoscopic adrenalectomy has been reported. We present the various considerations for determining the surgical approach and the optimal timing for surgery. Adrenalectomy during pregnancy for the treatment of Cushing's syndrome caused by adrenocortical adenoma has been reported in 23 patients in the English-language medical literature to date and seems safe and beneficial. According to the data, surgical treatment has led to a reduction in perinatal mortality and maternal morbidity rates, but has not affected the occurrence of preterm birth and intrauterine growth restriction. The best outcome can be achieved by a multidisciplinary approach, with a team comprising a maternal-fetal medicine specialist, an endocrinologist and a surgeon. The timing of surgery and the surgical approach need to be determined according to the surgeon's expertise, the severity of the condition, the patient's preferences, and gestational age. Laparoscopy may prove to be the preferred surgical approach. The small number of cases precludes providing evidence-based recommendations.
Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Affiliated with Technion-Israel Institute of Technology, Haifa, Israel. rsammour2002@gmail.com
Rami N
RN
Sammour
Leonard
L
Saiegh
Ibrahim
I
Matter
Ron
R
Gonen
Carmela
C
Shechner
Max
M
Cohen
Gonen
G
Ohel
Gabriel
G
Dickstein
D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects; D018246:Adrenocortical Adenoma / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D003480:Cushing Syndrome / Q000209:etiology* / Q000517:prevention & control; D016640:Diabetes, Gestational / Q000178:diet therapy / Q000517:prevention & control; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D010535:Laparoscopy; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000503:physiopathology / Q000601:surgery*; D011263:Pregnancy Trimester, Third; D047929:Term Birth; D016896:Treatment Outcome
D006854:Hydrocortisone