Conundrums of Diagnosis and Management of Cushing's Syndrome in Pregnancy

Monica Livia Gheorghiu; Maria Fleseriu

doi:10.1016/j.ecl.2024.05.007

Conundrums of Diagnosis and Management of Cushing's Syndrome in Pregnancy

Endocrinol Metab Clin North Am. 2024 Sep;53(3):421-435. doi: 10.1016/j.ecl.2024.05.007.

Authors

Monica Livia Gheorghiu¹, Maria Fleseriu²

Affiliations

¹ Department of Clinical Endocrinology IV, Carol Davila University of Medicine and Pharmacy Bucharest, Romania; CI Parhon National Institute of Endocrinology, 34-36 Aviatorilor Boulevard, Sector 1, 011863, Bucharest, Romania.
² Department of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon, USA; Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA; Pituitary Center, Oregon Health & Science University, Portland, OR, USA. Electronic address: [email protected].

PMID: 39084817
DOI: 10.1016/j.ecl.2024.05.007

Abstract

Pregnancy is rare in women with Cushing's syndrome (CS), due to hypercortisolism-induced gonadotropin suppression and anovulation. Diagnosis of CS is hampered by physiological cortisol level increases during normal pregnancy; importantly abnormal cortisol secretion circadian rhythm could be diagnostic. Active CS is associated with considerable maternal and fetal complications. Second trimester surgery (pituitary or adrenal) is the main treatment option, however observation in mild cases has been suggested. Medical treatment, although not approved for use in pregnancy, may be considered, after careful discussion and balancing any benefits with potential risks and side-effects.

Keywords: Complications; Cushing’s disease (CD); Cushing’s syndrome (CS); Diagnosis; Hypercortisolism; Management; Pregnancy; Treatment.

Publication types

Review

MeSH terms

Cushing Syndrome* / diagnosis
Cushing Syndrome* / therapy
Female
Humans
Pregnancy
Pregnancy Complications* / diagnosis
Pregnancy Complications* / therapy