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Cholekho S, Liu Y, Tan H. Cushing's syndrome during pregnancy - two case reports. Front Endocrinol (Lausanne) 2024; 15:1326496. [PMID: 38532898 PMCID: PMC10963388 DOI: 10.3389/fendo.2024.1326496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Background Cushing's syndrome (CS) during pregnancy is a rare endocrine disorder characterized by hypercortisolism, which is significantly associated with maternal-fetal complications. Despite its rarity, CS during pregnancy may be related to a high risk of complications for both the mother and fetus.The aim of the present case study is to update the diagnostic approach to CS during pregnancy and the therapeutic strategies for this medical condition to minimize maternal-fetal complications. Methods Here, we present two cases of CS in pregnant women, one of whom had twins. Typical clinical symptoms and signs of hypercortisolism developed at the beginning of pregnancy. The plasma cortisol diurnal rhythm of the pregnant patient was absent. CS was confirmed by cortisol and adrenocorticotropic hormone (ACTH) assessment, as well as imaging examination. We investigated the changes in the hypothalamic-pituitary-adrenal axis during normal pregnancy and the etiology, diagnosis and treatment of CS during pregnancy. Conclusion Due to the associated risks of laparoscopic adrenalectomy,it is uncertain whether this treatment significantly decreases overall maternal mortality. Additional observational research and validation through randomized controlled trials (RCTs) are required. We advise that CS in pregnant women be diagnosed and treated by experienced teams in relevant departments and medical centers.
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Affiliation(s)
| | | | - Huiwen Tan
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
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2
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Morris JA, Campbell P, Xu L, O’Sullivan AJ. Cushing Syndrome due to Adrenocortical Carcinoma During Pregnancy. JCEM CASE REPORTS 2023; 1:luad118. [PMID: 38021076 PMCID: PMC10652247 DOI: 10.1210/jcemcr/luad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Indexed: 12/01/2023]
Abstract
Cushing syndrome resulting from adrenocortical carcinoma in pregnancy is exceedingly rare. There are no validated guidelines to establish a diagnosis or guide management in pregnancy. We provide a case of a 31-year-old woman presenting for management of diabetes in pregnancy who appeared cushingoid. She was subsequently diagnosed with ACTH-independent Cushing syndrome and experienced preterm labor at 33 weeks' gestation, delivering a healthy infant. Four weeks postpartum, the patient underwent a left adrenalectomy and was subsequently diagnosed with adrenocortical carcinoma.
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Affiliation(s)
| | - Peter Campbell
- Breast Endocrine Surgeon, St. George Hospital, Kogarah, NSW, 2217, Australia
| | - Lily Xu
- Department of Endocrinology, St. George Hospital, Kogarah, NSW, 2217, Australia
| | - Anthony John O’Sullivan
- Department of Endocrinology, St. George Hospital, Kogarah, NSW, 2217, Australia
- Professor of Medicine, St George and Sutherland Campus, School of Clinical Medicine, UNSW Sydney, Kogarah, NSW, 2217, Australia
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3
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Qiang X, Li Y, Bai Q, Huang J, Ma X, Wang W. Adrenocortical pheochromocytoma diagnosed during pregnancy: a case report. BMC Pregnancy Childbirth 2023; 23:527. [PMID: 37464302 DOI: 10.1186/s12884-023-05844-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
This paper reports a rare case of adrenocortical carcinoma (ACC) diagnosed during pregnancy presenting with gestational hypertension. Hypertensive disorders in pregnancy should receive enough attention to identify and exclude the possibility of adrenal diseases, thereby making a timely diagnosis and active treatment.
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Affiliation(s)
| | - Yin Li
- The Third People's Hospital of Yunnan Province (The Second Affiliated Hospital of Dali University, 292 Beijing Road, Kunming City, Yunnan Province, China
| | - Qing Bai
- The Third People's Hospital of Yunnan Province (The Second Affiliated Hospital of Dali University, 292 Beijing Road, Kunming City, Yunnan Province, China
| | - Jing Huang
- The Third People's Hospital of Yunnan Province (The Second Affiliated Hospital of Dali University, 292 Beijing Road, Kunming City, Yunnan Province, China
| | - Xuemei Ma
- Dali University, Dali City, Yunnan Province, China
| | - Weiwei Wang
- Dali University, Dali City, Yunnan Province, China
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4
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Baghlaf HA, Badeghiesh AM, Suarthana E, Dahan MH. The effect of Cushing's syndrome on pregnancy complication rates: analysis of more than 9 million deliveries. J Matern Fetal Neonatal Med 2021; 35:6236-6242. [PMID: 34459316 DOI: 10.1080/14767058.2021.1910658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE The purpose of this study to evaluate the risk of Cushing's syndrome (CS) and maternal and fetal complications using the American Nationwide Inpatient Sample database. MATERIALS AND METHODS This is a retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database from 2004 to 2014. We compared pregnancies with CS versus non-CS regarding pregnancy, delivery, and neonatal outcomes using multivariate logistic regression. RESULTS We identified 9,096,788 pregnancies during the study period. Cushing's syndrome complicated 135 pregnancies at a rate of 1-2 cases per 100,000 births. Cushing's syndrome subjects were more likely to be older, obese, have private insurance, chronic hypertension, and pre-gestational diabetes (p<.001). The maternal mortality rate was 0.7 and 0.007% in Cushing's syndrome and control groups, respectively, although due to small numbers of cases, this should be interpreted with caution. Preeclampsia was higher in CS compared to controls after controlling for confounding variables, aOR 2.20. Operative vaginal delivery and blood transfusion rates were higher in CS patients than controls after controlling for confounding factors, aOR 6.49 and 3.09, respectively. The rates of preterm delivery (8.9 versus 7.2%) and gestational diabetes (8.1 versus 5.8%) were not statistically different between CS and control groups. CONCLUSION Cushing's syndrome patients begin pregnancies often with maladies making them more at risk for complications including, preeclampsia, blood transfusion, and operative vaginal delivery. These patients might benefit from prevention methods for preeclampsia, and increased surveillance to decrease maternal morbidity and mortality. However, the nature of the database and its limitations, including the lack of information about CS activity and treatments received by patients, warrant careful interpretation of these results.
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Affiliation(s)
- Haitham A Baghlaf
- Obstetrics & Gynecology Department, Division of Maternal-Fetal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ahmad M Badeghiesh
- Department of Obstetrics & Gynecology, McGill University, Montreal, Quebec, Canada
| | - Eva Suarthana
- Department of Obstetrics & Gynecology, McGill University, Montreal, Quebec, Canada
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, MUHC Reproductive Center, McGill University, Montreal, Quebec, Canada
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5
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Štěpáníková I, Baker E, Oates G, Bienertova-Vasku J, Klánová J. Assessing Stress in Pregnancy and Postpartum: Comparing Measures. Matern Child Health J 2020; 24:1193-1201. [PMID: 32691358 PMCID: PMC7476971 DOI: 10.1007/s10995-020-02978-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Introduction Measuring early-life psychosocial stress is complicated by methodological challenges. This paper compares three survey instruments for the assessment of life in pregnancy/postpartum and investigates the effects of the timing of early-life stress for emotional/behavioral difficulties (EBD) of offspring during mid/late childhood and adolescence. Methods Observational data were obtained from the European Longitudinal Cohort Study of Pregnancy and Childhood (ELSPAC-CZ), which included 4811 pregnancies in two Czech metropolitan areas. We used data collected between 1991 and 2010 at 20 weeks of pregnancy (T1), after delivery (T2), at 6 months postpartum (T3), and at child’s age of 7 years (T4), 11 years (T5), 15 years (T6), and 18 years (T7). Life stress was assessed with (1) the Edinburgh Postnatal Depression Scale (EPDS), (2) a stressful life events (SLE) count based on 42-item inventory, and (3) the SLE measure weighted by perceived stressfulness (PS). Each stress measure was administered at T1, T2, and T3. Child’s EBD were assessed with the Strengths and Difficulties Questionnaire at T4, T5, T6, and T7. Results Each stress measure independently predicted long-term EBD. The best data fit was obtained in a model combining EPDS and SLE. Effect sizes for SLEs decreased between the first half of pregnancy and postpartum, while the effect of EPDS increased. Discussion SLE-based methods capture an aspect of perinatal stress not adequately assessed by EPDS. Combination of psychological distress measures and SLE-based measures is optimal in predicting EBD of the child. Stress measures based on SLE are suitable for early pregnancy, while self-reports of depressive symptoms may perform better in postpartum.
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Affiliation(s)
- Irena Štěpáníková
- Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic. .,Sociology Department, University of Alabama at Birmingham, 1401 University Blvd. HHB, Birmingham, AL, USA. .,Denisa Ludvikova Vizentova, Masarykova univerzita Kotlářská 2, Brno, 61137, Czech Republic.
| | - Elizabeth Baker
- Sociology Department, University of Alabama at Birmingham, 1401 University Blvd. HHB, Birmingham, AL, USA
| | - Gabriela Oates
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julie Bienertova-Vasku
- Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic.,Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Klánová
- Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic
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6
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Chu PY, Burks ML, Sólorzano CC, Bao S. ROBOTIC PARAGANGLIOMA RESECTION IN A PREGNANT PATIENT. AACE Clin Case Rep 2020; 6:e197-e200. [PMID: 32984520 DOI: 10.4158/accr-2019-0558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/07/2020] [Indexed: 12/16/2022] Open
Abstract
Objective Functional paragangliomas in pregnancy are rare; however, if not recognized and treated early, they can be life-threatening. New treatment approaches with robotic resection are promising. Methods We present a case of a pregnant female with a paraganglioma which was successfully resected during the second trimester using Da Vinci Xi robotic system. Paraganglioma was diagnosed with plasma and urinary catecholamines and metanephrines, a contrast computed tomography (CT) scan, and confirmed with surgical pathology. Results The patient was initially seen in the emergency room prior to the index pregnancy for nausea, vomiting, and intermittent, left lower quadrant abdominal pain, episodic sweating, palpitations, and anxiety. CT scan of the abdomen and pelvis showed a 4.8 × 4.3 cm heterogeneously enhancing mass in the left retroperitoneum adjacent to the aorta just below the left adrenal gland. She had normal plasma metanephrines but elevated plasma normetanephrines of 7.12 nmol/L (normal, <0.89 nmol/L). Twenty-four-hour urine norepinephrine and catecholamines were elevated to 604 μg (normal, <90 μg/24 hours) and 610 μg (normal, <115 μg/24 hours), respectively. Chromogranin A was elevated to 940 ng/mL (normal, 0 to 95 ng/mL). Paraganglioma was suspected. Doxazosin was started for blood pressure control. The patient became pregnant unexpectedly shortly after. She was managed by a multidisciplinary team. At 18 weeks of pregnancy, she underwent a transabdominal robotic resection of the left retroperitoneal paraganglioma with an excellent outcome. Conclusion Functional paragangliomas in pregnancy are rare but must be recognized and treated early to reduce maternal and fetal complications. An innovative robotic approach should be considered and explored.
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Affiliation(s)
- Patricia Y Chu
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret L Burks
- Division of Endocrinology, Department of Internal Medicine, Vanderbilt University, Nashville, Tennessee
| | - Carmen C Sólorzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt Endocrine Surgery Center, General Surgery, VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shichun Bao
- Division of Endocrinology, Department of Internal Medicine, Vanderbilt University, Nashville, Tennessee
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7
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Lu Z, Luo B, Yuan Y, Yi X, Liang T, Xiong L, Jiang Y, Lo R. Retroperitoneal laparoscopic resection of adrenal tumor in pregnant woman with cushing's syndrome. Gynecol Endocrinol 2020; 36:465-468. [PMID: 31793359 DOI: 10.1080/09513590.2019.1698022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Cushing's syndrome (CS) during pregnancy is rare. It causes the clinical disorder by overproduction of cortisol. Hypercortisolemia in pregnancy can lead to severe complications, both for the mother and the fetus, including spontaneous abortion, perinatal death, prematurity, maternal hypertension, heart failure, diabetes and opportunistic infections. The most common cause of hypercortisolemia in pregnancy is a cortisol-secreting adrenal tumor. Herein we present a 31 year-old female patient, at 20 weeks' gestation, with CS secondary to a left adrenal tumor. A brief review of reported similar cases is included.
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Affiliation(s)
- Zhenquan Lu
- Division of Urology, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P. R. China
| | - Bingfeng Luo
- Division of Urology, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P. R. China
| | - Yuan Yuan
- Division of Urology, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P. R. China
| | - Xiang Yi
- Division of Urology, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P. R. China
| | - Tuo Liang
- Division of Urology, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P. R. China
| | - Lin Xiong
- Division of Urology, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P. R. China
| | - Yi Jiang
- Division of Urology, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P. R. China
| | - Richard Lo
- Division of Urology, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, P. R. China
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8
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Lin W, Huang HB, Wen JP, Wang NY, Wang SY, Wang C, Chen G. Approach to Cushing's syndrome in pregnancy: two cases of Cushing's syndrome in pregnancy and a review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:490. [PMID: 31700926 DOI: 10.21037/atm.2019.07.94] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cushing's syndrome (CS) rarely occurs during pregnancy. The primary aim of this article is to propose a therapeutic approach to CS in pregnancy. Here, we present two cases of CS in pregnancy and a literature review. This article proposes the early diagnostic points, especially the clinical approach to this medical condition, mainly for pregnant women without a previous diagnosis of CS. More importantly, we present therapeutic strategies for CS during pregnancy, especially glucocorticoid replacement for perioperative, postoperative, and perinatal periods in pregnant women with CS in order to minimize complications for both mother and fetus. At the same time, we also assess the anxiety status of patients. This article summarizes the approach to CS in pregnancy, not only with a physiological assessment but with a psychological assessment as well.
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Affiliation(s)
- Wei Lin
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Hui-Bin Huang
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Jun-Ping Wen
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Neng-Ying Wang
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Shuang-Yu Wang
- Department of Imaging, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Chen Wang
- Department of Pathology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Gang Chen
- Department of Endocrinology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China
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9
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Manoharan M, Sinha P, Sibtain S. Adrenal disorders in pregnancy, labour and postpartum - an overview. J OBSTET GYNAECOL 2019; 40:749-758. [PMID: 31469031 DOI: 10.1080/01443615.2019.1648395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Adrenal disorders may manifest during pregnancy for the first time, or present from before pregnancy as either undiagnosed or diagnosed and treated. They may present as hormonal hypofunction or hyperfunction, or with mass effects or other non-endocrine effects. Adrenal disorders such as Cushing's syndrome, Addison's disease, pheochromocytoma, primary hyper-aldosteronism and adreno-cortical carcinoma are rare in pregnancy. Pregnancy presents special problems in the evaluation of the hypothalamic-pituitary-adrenal and renin-angiotensin-aldosterone axis as these undergoe major changes during pregnancy. Diagnosis is challenging as symptoms associated with pregnancy are also seen in adrenal diseases. A timely diagnosis and treatment is critical as these disorders can cause maternal and foetal morbidity and mortality. A high index of suspicion must be maintained as they can go unrecognised and untreated. An early diagnosis and treatment often improves outcomes. The aim of this article is to review the patho-physiology, clinical manifestation, diagnosis and management of various adrenal disorders during pregnancy.
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Affiliation(s)
| | - Prabha Sinha
- Department of Obstetrics and Gynaecology, Oman Medical College, Muscat, Oman
| | - Shabnum Sibtain
- Department of Obstetrics and Gynaecology, Azra Naheed Medical College, Lahore, Pakistan
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10
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A successful pregnancy in a patient with secondary hypertension caused by adrenal adenoma: a case report. BMC Pregnancy Childbirth 2019; 19:116. [PMID: 30943935 PMCID: PMC6448298 DOI: 10.1186/s12884-019-2262-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/25/2019] [Indexed: 02/06/2023] Open
Abstract
Background Secondary hypertension is a rare complication in pregnancy that causes poor outcomes, such as preeclampsia, premature delivery, intrauterine growth retardation, stillbirths, spontaneous abortion or intrauterine death. Cushing’s disease caused by an adrenal adenoma is rare during pregnancy and may be overlooked by obstetricians and physicians, but can lead to hypertension, diabetes mellitus and an increased risk of fetal and maternal morbidity. Approximately 200 cases have been reported in the literature. Here, we report the successful management of a pregnant patient with Cushing’s syndrome due to an adrenal adenoma. Case presentation The 35-year-old Chinese female had no individual or family medical history of hypertension, and did not exhibit chronic kidney disease, diabetes mellitus, autoimmune and common endocrine diseases. Her blood pressure was elevated from the 16th week of gestation and was not controlled by 30 mg nifedipine twice a day. Examination in our department revealed her 24 h urinary free cortisol (24 h UFC) level was 1684.3 μg/24 h (normal range: 20.26–127.55 μg/24 h) and plasma adrenocorticotropic hormone was < 1.00 ng/L in three independent measurements (normal range: 5–78 ng/L). Ultrasonography demonstrated a mass (2.9 cm × 2.8 cm) in the right side of the adrenal gland. Magnetic resonance imaging without contrast showed a 3.2 cm diameter mass in the right-side of the adrenal gland. Other medical tests were normal. Laparoscopic adrenalectomy was performed at the 26th week of gestation by a urological surgeon in the West China Hospital. Histopathology revealed an adrenocortical adenoma. After surgery, the patient accepted glucocorticoid replacement therapy. The remaining trimester continued without complication and her blood pressure was normal at the 32nd week of gestation without antihypertensive therapy. The patient gave birth to a healthy boy at the 40th week of gestation. Conclusions Cushing’s syndrome caused by adrenal adenoma is rare during pregnancy. This unique case suggested that analysis of the UFC level and circadian rhythm of plasma cortisol provides a suitable strategy to diagnose Cushing’s syndrome during pregnancy. Laparoscopic surgical resection in the second trimester provides a reasonable approach to treat pregnant patients exhibiting Cushing’s syndrome caused by an adrenal adenoma.
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Calina D, Docea AO, Golokhvast KS, Sifakis S, Tsatsakis A, Makrigiannakis A. Management of Endocrinopathies in Pregnancy: A Review of Current Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050781. [PMID: 30836653 PMCID: PMC6427139 DOI: 10.3390/ijerph16050781] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 12/29/2022]
Abstract
Pregnancy in women with associated endocrine conditions is a therapeutic challenge for clinicians. These disorders may be common, such us thyroid disorders and diabetes, or rare, including adrenal and parathyroid disease and pituitary dysfunction. With the development of assisted reproductive techniques, the number of pregnancies with these conditions has increased. It is necessary to recognize symptoms and correct diagnosis for a proper pharmacotherapeutic management in order to avoid adverse side effects both in mother and fetus. This review summarizes the pharmacotherapy of these clinical situations in order to reduce maternal and fetal morbidity.
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Affiliation(s)
- Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
| | | | - Stavros Sifakis
- Department of Obstetrics and Gynecology, Mitera Maternity Hospital, 71110 Heraklion, Crete, Greece.
| | - Aristides Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71110 Heraklion, Crete, Greece.
| | - Antonis Makrigiannakis
- Department of Obstetrics and Gynecology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece.
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12
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Machado MC, Fragoso MCBV, Bronstein MD. Pregnancy in Patients with Cushing's Syndrome. Endocrinol Metab Clin North Am 2018; 47:441-449. [PMID: 29754643 DOI: 10.1016/j.ecl.2018.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Progress in diagnosis and treatment of endocrine diseases has made pregnancy possible for women with endocrinopathies, including Cushing's syndrome (CS). The risk of maternal-fetal complications in patients who are not biochemically controlled, however, is substantial. Therefore, the surgical and/or medical control of hypercortisolism is mandatory prior to conceiving. A diagnosis of de novo CS during gestation is difficult due to changes in the hypothalamic-pituitary-adrenal axis during pregnancy, which may lead to some clinical features suggestive of CS along with abnormal laboratory tests. This review presents the diagnosis and management of CS during pregnancy.
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Affiliation(s)
- Marcio Carlos Machado
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, Avenida Enéas de Carvalho Aguiar, n° 155, 8° andar, bloco 03, São Paulo, São Paulo 05403-000, Brazil; Endocrinology Service, AC Camargo Cancer Center, Rua Prof. Antonio Prudente n° 211, São Paulo, SP 01509-010, Brazil; Laboratory for Endocrinology Cellular and Molecular - LIM25, University of São Paulo Medical School, Av. Dr. Arnaldo, 455, 4° andar, São Paulo, SP 01246-903, Brazil
| | - Maria Candida Barisson Vilares Fragoso
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, Avenida Enéas de Carvalho Aguiar, n° 155, 8° andar, bloco 03, São Paulo, São Paulo 05403-000, Brazil
| | - Marcello Delano Bronstein
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, Avenida Enéas de Carvalho Aguiar, n° 155, 8° andar, bloco 03, São Paulo, São Paulo 05403-000, Brazil.
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13
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Evaluating Stress during Pregnancy: Do We Have the Right Conceptions and the Correct Tools to Assess It? J Pregnancy 2018; 2018:4857065. [PMID: 29484210 PMCID: PMC5816839 DOI: 10.1155/2018/4857065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/19/2017] [Indexed: 01/08/2023] Open
Abstract
Gestational stress is believed to increase the risk of pregnancy failure and perinatal and adult morbidity and mortality in both the mother and her child or children. However, some contradictions might arise from methodological issues or even from differences in the philosophical grounds that guide the studies on gestational stress. Biased perspectives could lead us to use and/or design inadequate/incomplete panels of biochemical determinations and/or psychological instruments to diagnose it accurately during pregnancy, a psychoneuroimmune-endocrine state in which allostatic loads may be significant. Here, we review these notions and propose a model to evaluate and diagnose stress during pregnancy.
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14
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Andreescu CE, Alwani RA, Hofland J, Looijenga LHJ, de Herder WW, Hofland LJ, Feelders RA. Adrenal Cushing's syndrome during pregnancy. Eur J Endocrinol 2017; 177:K13-K20. [PMID: 28819015 DOI: 10.1530/eje-17-0263] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/06/2017] [Accepted: 08/17/2017] [Indexed: 12/25/2022]
Abstract
Cushing syndrome (CS) during pregnancy is a rare condition with only a few cases reported in the literature. Misdiagnosis of CS is common because of overlapping features like fatigue, weight gain, striae and emotional changes that can occur during normal pregnancy. Changes in maternal hormones and their binding proteins complicate assessment of glucocorticoid hormone levels during gestation. CS during pregnancy is most frequently due to an adrenal adenoma and to a lesser degree to adrenocorticotropic hormone (ACTH) hypersecretion by a pituitary adenoma. Furthermore, aberrant expression of luteinizing hormone (LH) receptors in the adrenal cortex has been suggested to be involved in the pathogenesis of adrenal CS during pregnancy. We report three pregnant women with ACTH-independent Cushing's syndrome and an adrenal tumor. After uncomplicated delivery, patient 1 underwent in vivo testing for aberrant hormone receptor expression by the adenoma. Cortisol responses were found after administration of luteinizing hormone-releasing hormone (LHRH), human chorionic gonadotropin (hCG), glucagon, vasopressin and a standard mixed meal. All patients were treated with laparoscopic adrenalectomy. Adrenal tumor tissue of two patients showed positive immunohistochemical staining of LH receptors. Considering the cortisol responses to LHRH and hCG, and the development of CS during pregnancy in these patients, it is likely that ACTH-independent hypercortisolism was induced by the pregnancy-associated rise in hCG levels that activated aberrantly expressed LH receptors in the adrenal adenoma. Remarkably, adrenal adenomas may simultaneously express multiple aberrant receptors and individual ligands may play a role in the regulation of cortisol production in CS during pregnancy.
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Affiliation(s)
- C E Andreescu
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Endocrinology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - R A Alwani
- IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - J Hofland
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - L H J Looijenga
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - W W de Herder
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - L J Hofland
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R A Feelders
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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15
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van der Weerd K, van Noord C, Loeve M, Knapen MFCM, Visser W, de Herder WW, Franssen G, van der Marel CD, Feelders RA. ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature. Eur J Endocrinol 2017; 177:R49-R58. [PMID: 28381449 DOI: 10.1530/eje-16-0920] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 03/29/2017] [Accepted: 04/05/2017] [Indexed: 11/08/2022]
Abstract
Pheochromocytoma in pregnancy is extremely rare. Early recognition is crucial as antepartum diagnosis can largely decrease maternal and fetal mortality rates. As symptoms of pheochromocytoma are rather similar to those of other far more common causes of hypertension during pregnancy, timely diagnosis is a challenge. In pregnant patients, similar to non-pregnant patients, increased plasma and/or 24-h urine (nor)metanephrine concentrations most reliably confirm the diagnosis of pheochromocytoma. MRI and ultrasound are the only imaging modalities that can be used safely during pregnancy to localize the tumor. During pregnancy, pretreatment consists of alpha blockade as usual. However, dosing of α-adrenergic receptor blockers during pregnancy is a challenge as hypertension must be treated while preserving adequate uteroplacental circulation. When the diagnosis is made within the first 24 weeks of pregnancy, it is generally recommended to remove the tumor in the second trimester, while resection is generally postponed till after delivery when the diagnosis is made in the third trimester and medical pretreatment is sufficient. Both during and after pregnancy, laparoscopic surgery is the preferred approach for resection of the tumor. There is no consensus in literature about the preferred route and timing of delivery. Therefore, in our opinion, decisions should be made on an individual basis by an experienced and dedicated multidisciplinary team. Over the last decades, maternal and fetal prognosis has improved considerably. Further increasing awareness of this rare diagnosis and treatment of these patients by a dedicated team in a tertiary referral hospital are critical factors for optimal maternal and fetal outcome.
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Affiliation(s)
- K van der Weerd
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - C van Noord
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - M Loeve
- Department of Anesthesiology, Unit of Obstetric Anesthesiology
| | - M F C M Knapen
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, The Netherlands
| | - W Visser
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - W W de Herder
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - G Franssen
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - R A Feelders
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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16
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Caimari F, Valassi E, Garbayo P, Steffensen C, Santos A, Corcoy R, Webb SM. Cushing's syndrome and pregnancy outcomes: a systematic review of published cases. Endocrine 2017; 55:555-563. [PMID: 27704478 DOI: 10.1007/s12020-016-1117-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/07/2016] [Indexed: 12/13/2022]
Abstract
Pregnancy in Cushing's syndrome (CS) is extremely rare due to the influence of hypercortisolism on the reproductive axis. Purpose of this study is to investigate whether the etiology of CS in pregnancy determines a different impact on the fetal/newborn and maternal outcomes. We performed a systematic review of cases published in the literature from January 1952 to April 2015 including the words "Cushing AND pregnancy". We included 168 manuscripts containing 220 patients and 263 pregnancies with active CS during pregnancy and with a history of CS but treated and cured hypercortisolism at the time of gestation. Adrenal adenoma was the main cause of active CS during pregnancy (44.1 %). Women with active CS had more gestational diabetes mellitus (36.9 vs. 2.3 %, p = 0.003), gestational hypertension (40.5 vs. 2.3 %, p < 0.001) and preeclampsia (26.3 vs. 2.3 %, p = 0.001) than those with cured disease. The proportion of fetal loss in active CS was higher than in cured CS (23.6 vs. 8.5 %, p = 0.021), as well as global fetal morbidity (33.3 vs. 4.9 %, p < 0.001). The predictors of fetal loss in active CS were etiology of hypercortisolism [Odds Ratio -OR-for pregnancy-induced CS 4.7 (95 % Confidence Interval-CI 1.16-18.96), p = 0.03], publication period [OR for "1975-1994" 0.10 (95 % CI 0.03-0.40), p = 0.001] and treatment during gestation (p = 0.037, [OR medical treatment 0.25 (95 % CI 0.06-1.02), p = 0.052], [OR surgical treatment 0.34 (95 % CI 0.11-1.06), p = 0.063]). The period of diagnosis of CS (before, during or after pregnancy) was the only predictor of overall fetal morbimortality [OR for diagnosis during pregnancy 4.66 (95 % CI 1.37-15.83), p = 0.014]. Patients with active CS, especially in pregnancy-induced CS, experienced more problems in pregnancy and had the worst fetal prognosis in comparison to other causes. Diagnosis of CS during pregnancy was also associated with worse overall fetal morbimortality. Both medical treatment and surgery during pregnancy appeared to be protective in avoiding fetal loss.
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Affiliation(s)
- Francisca Caimari
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain
| | - Elena Valassi
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | | | - Alicia Santos
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Rosa Corcoy
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, Spain
| | - Susan M Webb
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, Instituto de Salud Carlos III, Madrid, Spain.
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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17
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Schneiderman M, Czuzoj-Shulman N, Spence AR, Abenhaim HA. Maternal and neonatal outcomes of pregnancies in women with Addison's disease: a population-based cohort study on 7.7 million births. BJOG 2016; 124:1772-1779. [PMID: 27981742 DOI: 10.1111/1471-0528.14448] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess if pregnancies among women with Addison's disease (AD) are at higher risk of adverse maternal and neonatal outcomes. DESIGN Population-based retrospective cohort study. SETTING/POPULATION All births in the United States' Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2011. METHODS Baseline characteristics were compared between women with AD and those without, and prevalence over time was measured. Logistic regression was used to estimate the effect of AD on maternal and neonatal outcomes by calculating the crude and adjusted odds ratios (OR) and corresponding 95% confidence intervals (95% CI). RESULTS We calculated a prevalence of AD in pregnancy of 5.5/100 000, increasing from 5.6 to 9.6/100 000 (P = 0.0001) over the 9-year study period. Compared with women without AD, women with AD were more likely to deliver preterm (OR 1.50, 95% CI 1.16-1.95), deliver by caesarean section (OR 1.32, 95% CI 1.08-1.61), have impaired wound healing (OR 4.28, 95% CI 2.55-7.18), develop infections (OR 2.44, 95% CI 1.66-3.58) and develop thromboembolism (OR 5.21, 95% CI 2.15-12.63), require transfusions (OR 6.69, 95% CI 4.69-9.54), and have prolonged postpartum hospital admissions (OR 5.71, 95% CI 4.37-7.47). Maternal mortality was significantly higher than in the comparison group (OR 22.30, 95% CI 6.82-72.96). Congenital anomalies (OR 3.62, 95% CI 2.05-6.39) and small-for-gestational age infants (OR 1.78, 95% CI 1.15-2.75) were more likely in these pregnancies. CONCLUSIONS Addison's disease significantly increases the risk of severe adverse maternal and neonatal outcomes, so pregnant women with AD are best managed in tertiary-care centres. TWEETABLE ABSTRACT Pregnancies complicated by Addison's disease have an increased risk of adverse maternal and neonatal outcomes.
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Affiliation(s)
- M Schneiderman
- Department of Obstetrics and Gynaecology, Jewish General Hospital, Montreal, QC, Canada
| | - N Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
| | - A R Spence
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
| | - H A Abenhaim
- Department of Obstetrics and Gynaecology, Jewish General Hospital, Montreal, QC, Canada.,Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
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18
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Landau E, Amar L. Primary aldosteronism and pregnancy. ANNALES D'ENDOCRINOLOGIE 2016; 77:148-60. [PMID: 27156905 DOI: 10.1016/j.ando.2016.04.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
Abstract
Hypertension (HT) is a complication of 8% of all pregnancies and 10% of HT cases are due to primary aldosteronism (PA). There is very little data on PA and pregnancy. Given the changes in the renin angiotensin system during pregnancy, the diagnosis of PA is difficult to establish during gestation. It may be suspected in hypertensive patients with hypokalemia. A comprehensive literature review identified reports covering 40 pregnancies in patients suffering from PA. Analysis of these cases shows them to be high-risk pregnancies leading to maternal and fetal complications. Pregnancy must be programmed, and if the patient has a unilateral form of PA, adrenalectomy should be performed prior to conception. It is customary to stop spironolactone prior to conception and introduce antihypertensive drugs that present no risk of teratogenicity. When conventional antihypertensive drugs used during pregnancy fail to control high blood pressure, diuretics, including potassium-sparing diuretics may be prescribed. Adrenalectomy can be considered during the second trimester of pregnancy exclusively in cases of refractory hypertension. A European retrospective study is currently underway to collect a larger number of cases.
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Affiliation(s)
- Ester Landau
- Université Paris-Descartes Faculty of Medicine, 75006 Paris, France
| | - Laurence Amar
- Hypertension Unit, Assistance Publique-Hôpitaux de Paris, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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19
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Bronstein MD, Machado MC, Fragoso MCBV. MANAGEMENT OF ENDOCRINE DISEASE: Management of pregnant patients with Cushing's syndrome. Eur J Endocrinol 2015; 173:R85-91. [PMID: 25872515 DOI: 10.1530/eje-14-1130] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/14/2015] [Indexed: 11/08/2022]
Abstract
Progress in the diagnosis and treatment of endocrine diseases has turned pregnancy into a possibility for women with such medical disorders, including Cushing's syndrome (CS). Nevertheless, despite its rarity, pregnancy in patients with CS can be troublesome because of the risk of maternal-fetal complications. Therefore, hypercortisolism, if present, should be surgically or medically controlled in most cases. Moreover, changes in the hypothalamic-pituitary-adrenal axis during normal pregnancy may mislead the diagnosis of CS during this period, because many laboratory assessments suggestive of CS may be present in normal pregnancy, with clinical features mimicking those seen in patients with CS. The aim of the present review is to update the diagnostic approach to this medical condition, mainly for pregnant women without previous diagnosis of CS, and to describe the therapeutic strategies for CS during pregnancy in order to minimize complications for both mother and fetus.
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Affiliation(s)
- M D Bronstein
- Neuroendocrine UnitAdrenal UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, Avenida Enéas de Carvalho Aguiar, 155 8° andar Bloco 03São Paulo, São Paulo 05403-000, Brazil
| | - M C Machado
- Neuroendocrine UnitAdrenal UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, Avenida Enéas de Carvalho Aguiar, 155 8° andar Bloco 03São Paulo, São Paulo 05403-000, Brazil
| | - M C B V Fragoso
- Neuroendocrine UnitAdrenal UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, Avenida Enéas de Carvalho Aguiar, 155 8° andar Bloco 03São Paulo, São Paulo 05403-000, Brazil Neuroendocrine UnitAdrenal UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, Avenida Enéas de Carvalho Aguiar, 155 8° andar Bloco 03São Paulo, São Paulo 05403-000, Brazil
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20
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Abstract
Adrenal diseases, including Cushing syndrome (CS), primary aldosteronism (PA), pheochromocytoma, and adrenocortical carcinoma, are uncommon in pregnancy; a high degree of clinical suspicion must exist. Physiologic changes to the hypothalamus-pituitary-adrenal axis in a normal pregnancy result in increased cortisol, renin, and aldosterone levels, making the diagnosis of CS and PA in pregnancy challenging. However, catecholamines are not altered in pregnancy and allow a laboratory diagnosis of pheochromocytoma that is similar to that of the nonpregnant state. Although adrenal tumors in pregnancy result in significant maternal and fetal morbidity, and sometimes mortality, early diagnosis and appropriate treatment often improve outcomes.
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Affiliation(s)
- Deirdre Cocks Eschler
- Endocrinology Division, Department of Medicine, Stony Brook University School of Medicine, HSC T15-060, Stony Brook, NY 11794, USA.
| | - Nina Kogekar
- Department of Medicine, Mount Sinai School of Medicine, 1 Gustave L Levy Place, New York, NY 10029, USA
| | - Rachel Pessah-Pollack
- Endocrinology Division, Department of Medicine, Mount Sinai School of Medicine, 1 Gustave L Levy Place, New York, NY 10029, USA; Department of Endocrinology, ProHealth Care Associates, Ohio Drive, Lake Success, NY 11042, USA
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21
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Katulski K, Podfigurna-Stopa A, Maciejewska-Jeske M, Ruchala M, Gurgul E, Szymankiewicz M, Breborowicz GH, Karmelita-Katulska K, Stajgis M, Biczysko M, Gryczynska M, Genazzani AR, Meczekalski B. Cushing's syndrome in pregnancy: a case report and mini review of the literature. Gynecol Endocrinol 2014; 30:345-9. [PMID: 24460501 DOI: 10.3109/09513590.2013.879857] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Adrenal diseases in pregnant women are diagnosed relatively rarely. The main cause of hypercortisolemia during pregnancy is Cushing's syndrome related to adrenal adenoma. It is important to diagnose Cushing's syndrome in pregnant women because it can lead to significant maternal and foetal complications and morbidity. However, due to physiological endocrine changes and symptoms in pregnant women the diagnosis of this disorder can be a challenge. One current case describes a 38-year-old pregnant woman with hypertension, oedema and an adrenal tumour. At the beginning, Conn syndrome was suspected, but after careful analysis Cushing's syndrome (with an adenoma of the right adrenal gland) was diagnosed. After delivery and 5 weeks of pharmacological treatment the patient underwent right side adrenalectomy by laparoscopy.
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Affiliation(s)
- K Katulski
- Department of Gynecological Endocrinology
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22
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Abstract
: Adrenal diseases--including disorders such as Cushing's syndrome, Addison's disease, pheochromocytoma, primary hyperaldosteronism and congenital adrenal hyperplasia--are relatively rare in pregnancy, but a timely diagnosis and proper treatment are critical because these disorders can cause maternal and fetal morbidity and mortality. Making the diagnosis of adrenal disorders in pregnancy is challenging as symptoms associated with pregnancy are also seen in adrenal diseases. In addition, pregnancy is marked by several endocrine changes, including activation of the renin-angiotensin-aldosterone system and the hypothalamic-pituitary-adrenal axis. The aim of this article was to review the pathophysiology, clinical manifestation, diagnosis and management of various adrenal disorders during pregnancy.
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23
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Laparoscopic Adrenalectomy for Hemorrahagic Adrenal Pseudocyst Discovered During Pregnancy. Surg Laparosc Endosc Percutan Tech 2013; 23:e200-4. [DOI: 10.1097/sle.0b013e31828f6663] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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