A case of Cushing’s syndrome during pregnancy

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  • IMAI Saeko
    Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center
  • EGAWA Haruto
    Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center
  • SEKIYAMA Kentaro
    Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center
  • NANBA Kazutaka
    Department of Endocrinology, National Hospital Organization Kyoto Medical Center
  • KAKITA Maiko
    Department of Endocrinology, National Hospital Organization Kyoto Medical Center
  • TAKAKURA Kenji
    Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center

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Other Title
  • Cushing症候群合併妊娠の1症例
  • 症例報告 Cushing症候群合併妊娠の1症例
  • ショウレイ ホウコク Cushing ショウコウグン ガッペイ ニンシン ノ 1 ショウレイ

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Abstract

As Cushing’s syndrome is usually associated with amenorrhea and infertility in women with hypercortisolism, the occurrence of this syndrome in pregnant woman is rare. The presence of hypercortisolism is associated with increased maternal or fetal mortality, as well as premature delivery. Here, we present a case of Cushing’s syndrome that developed due to an adrenal adenoma, which was diagnosed at the 18th week of pregnancy. A 41-year-old woman, gravid 1 para 1, presented to our clinic with amenorrhea. She had been receiving treatment for hypertension and a psychiatric disorder. At the 15th week of pregnancy, she was admitted to our hospital because of difficulty in managing her hypertension. A physical examination indicated the presence of certain clinical features of Cushing’s syndrome, including moon face and buffalo hump. The plasma adrenocorticotropic hormone level was undetectable. On abdominal ultrasonography, a tumor measuring 2.0 cm was identified in the left adrenal gland. Thus, we suspected that the adrenal adenoma caused the development of Cushing’s syndrome. At the 22nd week of pregnancy, left adrenalectomy was performed, and her blood pressure remained stable. Five days after surgery, her blood pressure gradually worsened. Due to the development of severe superimposed preeclampsia complicated with maternal multiple organ failures and disseminated intravascular coagulation syndrome, the patient was transferred to another perinatal intensive care unit. Intrauterine fetal death was noted on the day of the transfer. After delivery, she exhibited an immediate and drastic improvement. Thus, early diagnosis of hypertension in pregnancy is crucial to avoid serious maternal and fetal complications. Moreover the treatment modalities employed and the optimal time of termination should be carefully chosen on a case-by-case basis. [Adv Obstet Gynecol, 66 (1) : 11-17, 2014 (H26.2)]

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