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Pregnancy in Women Previously Treated for an Adrenocortical Carcinoma
Pauline de Corbière1, Katrin Ritzel1, Laure Cazabat1
1Department of Endocrinology (P.d.C., L.C., M.-L.R.S.), Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 92100 Boulogne Billancourt, France; Medizinische Klinik IV (K.R., M.F.), Klinikum der Universität München, München 80336, Germany; Inserm U1173 (L.C., M.-L.R.-S.), Université de Versailles St-Quentin-en-Yvelines, 78280 Montigny-le-Bretonneux, France; Unité de Recherche Clinique (J.R.), Hospitalo Universitaire Paris Île-de-France Ouest, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne, France; Funktionsbereich Spezielle Endokrinologie (M.S.), Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany; Department of Endocrinology (R.L., J.B., X.B.), Cochin University Hospital, AP-HP, French Adrenal Cancer Network COrtico MEdullo-surrénale Tumeur Endocrines (COMETE)-Cancer and Unite Mixte de Recherche 8104, Institut Cochin, 75014 Paris, France; Comprehensive Cancer Center Mainfranken (A.-C.K., M.F.), University of Würzburg, Würzburg, 97080 Germany; Institut Gustave Roussy (S.L.), 94800 Villejuif, France; Department of Medicine I (T.D., M.F.), Endocrine Unit, University Hospital, University of Würzburg, Würzburg, 97080 Germany; Centre Hospitalier Régional Universitaire de Lille (C.D.C.), Lille, 59000 France; Endocrinology and Diabetes Unit (S.H), Department of Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany; Department of Endocrinology (D.D.), Nantes University Hospital, 44000 Nantes, France; Department of Endocrinology and Nephrology (K.M.), University of Leipzig, 04357 Leipzig, Germany; Service d'Endocrinologie Maladies Métaboliques et Nutrition (P.C.), Pôle Cardio-Vasculaire et Métabolique, Centre Hospitalier Universitaire Larrey, 10623 Toulouse, France; Division of Endocrinology and Diabetology (J.W.), University Hospital Giessen and Marburg, Campus Marburg, 35041 Marburg, Germany; Department of Endocrinology (O.C.), Michallon Teaching Hospital, 38043 Grenoble, France; Endocrinol
Context:
Adrenocortical carcinomas (ACCs) are rare, aggressive tumors, of which some express receptors for estradiol, progesterone, and/or human chorionic gonadotoropin. Because this disease is encountered frequently in young women, pregnancy is a relevant issue.
Objective:
to evaluate the impact of pregnancy on outcome of patients previously treated for ACC.
Design/Setting:
retrospective observational multicenter study of the European Network for the Study of Adrenal Tumors.
Patients:
Seventeen ACC patients (21 pregnancies), becoming pregnant at least 3 months after the initial treatment, were compared with 247 nonpregnant ACC patients less than 47 years old. A control group of 34 patients matched for age, sex, and tumor stage was used for survival analysis.
Main Outcome Measure(S):
Overall survival, tumors characteristics at diagnosis, pregnancy outcome.
Results:
All 17 patients with pregnancies had localized ACC. The median time between surgery and conception was 4 years (0.3-12 y). Two pregnancies were terminated at 8 weeks. Sixteen women gave birth to 19 live infants. With exception of 1 (presumably unrelated) cardiac malformation, no severe fetal or maternal complication was observed. After a median follow-up time of 8.36 years and 5.26 years after the first conception, 1 of the 17 patients had died and 5 had experienced a recurrence, among whom 3 occurred before conception. Overall survival was not significantly different between the "pregnancy group" and the matched controls.
Conclusion:
Pregnancy in patients previously treated for ACC seems to not be associated with worse clinical outcome, although a "healthy mother effect" cannot be excluded.
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