Cushing syndrome in pregnancy caused by an adrenal adenoma

Abstract

Objective: The description of a rare case of Cushing syndrome caused by an adrenal adenoma in pregnancy with successful treatment.

Design: A case report

Setting: Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine and University Hospital Brno; Department of Internal gastroenterology, Faculty of Medicine and University Hospital Brno; Department of Gynecology and Obstetrics, Hospital Třebíč

Case presentation: 30 years old tercipara was admitted to our hospital with hypertension at 18th week of gestation. Hormonal analyses revealed primary Cushing syndrome with high plasma cortisol levels and low levels of adrenocorticotropic hormone. Magnetic resonance imaging demonstrated a mass in the right-side of the adrenal gland. Adrenalectomy was performed in the 28th week of gestation and following histopathology revealed an adrenocortical adenoma. Pregnancy continued until the 38th week of gestation with a glucocorticoid replacement therapy and the patient gave birth vaginally to a healthy boy in 38th weeks of gestation.

Conclusion: Cushing syndrome in pregnancy occurs rarely, diagnosis may be dismissed or determined after birth in most cases. Misdiagnosis of Cushing syndrome is common because of physiological increase of corticotropin hormones and cortisol levels and overlapping symptoms that can occur even during physiological pregnancy. Cushing syndrome should have a place in differential diagnosis of hypertension in pregnancy (especially before 20th weeks of gestation). Analysis of the urinary free cortisol level and circadian rhythm blood cortisol provided a reasonable strategy to diagnose Cushing syndrome in pregnant women. Early diagnosis and surgical treatment can significantly reduce maternal and fetal complications.

Keywords: adenoma, Cushing syndrome, pregnancy, hypertension