MANAGEMENT OF ENDOCRINE DISEASE: Management of Cushing's syndrome during Pregnancy: solved and unsolved questions.

MANAGEMENT OF ENDOCRINE DISEASE: Management of Cushing's syndrome during Pregnancy: solved and unsolved questions. Eur J Endocrinol. 2018 Mar 09;: Authors: Brue T, Amodru V, Castinetti F Abstract With fewer than 200 reported cases, Cushing's syndrome (CS) in pregnancy remains a diagnostic and therapeutic challenge. In normal pregnancies, misleading signs may be observed such as striae or hypokalemia, while plasma cortisol and urinary free cortisol may rise up to 2-3-fold. While the dexamethasone suppression test is difficult to use, reference values for salivary cortisol appear valid. The predominant cause is adrenal adenoma (sometimes without decreased ACTH), rather than Cushing's disease. There are considerable imaging pitfalls in Cushing's disease. Aberrant receptors may, in rare cases, lead to increased cortisol production during pregnancy in response to HCG, LHRH, glucagon, vasopressin or after a meal. Adrenocortical carcinoma (ACC) is rare and has poor prognosis. Active CS during pregnancy is associated with a high rate of maternal complications: hypertension or preeclampsia, diabetes, fractures; more rarely, cardiac failure, psychiatric disorders, infection and maternal death. Increased fetal morbidity includes prematurity, intrauterine growth retardation, and less prevalently stillbirth, spontaneous abortion, intrauterine death, and hypoadrenalism. Therapy is also challenging. Milder cases can be managed conservatively by con...
Source: European Journal of Endocrinology - Category: Endocrinology Authors: Tags: Eur J Endocrinol Source Type: research