[Cushing's syndrome during pregnancy].

Area of Science:

• Endocrinology
• Obstetrics & Gynecology
• Reproductive Medicine

Background:

• Cushing's syndrome, characterized by hypercortisolism, is rarely associated with pregnancy due to inherent infertility and amenorrhea.
• Literature reports 125 cases, with diagnosis occurring either early in pregnancy or in the latter half.

Purpose of the Study:

• To discuss the diagnostic challenges and management strategies for Cushing's syndrome during pregnancy.
• To highlight the impact of untreated hypercortisolism on maternal and fetal prognosis.

Main Methods:

• Review of existing literature on Cushing's syndrome in pregnancy.
• Analysis of diagnostic criteria, including clinical signs and specific hormonal assays.
• Evaluation of treatment approaches and their compatibility with pregnancy.

Main Results:

• Early diagnosis of Cushing's syndrome during pregnancy is challenging due to non-specific symptoms like weight gain, hypertension, and gestational diabetes.
• Standard diagnostic tests like 24-hour urine free cortisol and dexamethasone suppression tests have limited value after 14 weeks of amenorrhea.
• Diagnosis often relies on the loss of cortisol's circadian rhythm, with adrenal causes being frequent and requiring imaging to rule out tumors.

Conclusions:

• Maternal prognosis is influenced by hypertension, preeclampsia, diabetes, and the activity of hypercortisolism, necessitating early etiological treatment.
• Fetal prognosis is directly linked to maternal outcomes, with risks including preterm delivery, hypotrophy, and intrauterine fetal demise.
• Comprehensive management requires symptomatic and etiological treatment, prioritizing both maternal and obstetrical well-being.