Cushing’s syndrome in pregnancy caused by an adrenal adenoma

Česká verzia

Authors: Koudelková Zuzana ¹; Gerychová Romana ²; Nešporová Tereza ³
Authors place of work: Gynekologicko-porodnické oddělení, Nemocnice Třebíč, p. o. ¹; Gynekologicko-porodnická klinika LF MU a FN Brno ²; Interní gastroenterologická klinika LF MU a FN Brno ³
Published in the journal: Ceska Gynekol 2021; 86(5): 331-334
Category: Case Report
doi: https://doi.org/10.48095/cccg2021331

Summary

Objective: The description of a rare case of Cushing’s syndrome caused by an adrenal adenoma in pregnancy with successful treatment. Case presentation: 30-ear-old Gravida 3 female was admitted to our hospital with hypertension at the 18^th week of gestation. Hormonal analyses revealed primary Cushing’s syndrome with high plasma cortisol levels and low levels of adrenocorticotropic hormone. Magnetic resonance imaging demonstrated a mass on the right-side of the adrenal gland. Adrenalectomy was performed in the 28^th week of gestation and the following histopathology revealed an adrenocortical adenoma. Pregnancy continued until the 38^th week of gestation with glucocorticoid replacement therapy and the patient gave birth vaginally to a healthy boy in the 38^th week of gestation. Conclusion: Cushing’s syndrome in pregnancy rarely occurs; diagnosis may be dismissed or determined after birth in most cases. Misdiagnosis of Cushing’s syndrome is common because of physiological increase of corticotropin hormones and cortisol levels and overlapping symptoms that can occur even during physiological pregnancy. Cushing’s syndrome should have a place in the differential diagnosis of hypertension in pregnancy (especially before the 20^th week of gestation). Analysis of the urinary free cortisol level and circadian rhythm blood cortisol can provide a reasonable strategy to diagnose Cushing’s syndrome in pregnant women. Early diagnosis and surgical treatment can significantly reduce maternal and fetal complications.

Keywords:

hypertension – adenoma – pregnancy – Cushing’s syndrome

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