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Pregnancy-associated Cushing's disease? An exploratory retrospective study
Sheri K Palejwala1, Andrew R Conger1,2, Amy A Eisenberg1
1Pacific Neuroscience Institute, John Wayne Cancer Institute at Providence's Saint John's Health Center, 2125 Arizona Ave., Santa Monica, CA, 90404, USA.
Pituitary
|September 16, 2018
Summary
Over a quarter of women diagnosed with Cushing's disease (CD) experienced symptom onset within a year of childbirth. This suggests pregnancy may trigger CD, warranting increased clinical suspicion and testing post-delivery.
Area of Science:
- Endocrinology
- Reproductive Health
- Neurosurgery
Background:
- Cushing's disease (CD) predominantly affects women of reproductive age.
- Pregnancy may be a critical period for CD onset.
Purpose of the Study:
- To determine the incidence of CD onset associated with pregnancy.
Main Methods:
- Retrospective review of 77 patients with biochemically-proven CD.
- Pregnancy-associated CD defined as symptom onset within 1 year of childbirth.
- Analysis of demographics, clinical history, biochemistry, imaging, pathology, and outcomes.
Main Results:
- 11 of 64 women (27%) met criteria for pregnancy-associated CD.
- Women with pregnancy-associated CD had a higher median number of prior pregnancies (2 vs. 0).
- Sustained surgical remission rates were high across all groups (80-91%); average diagnostic lag time was 4 years for pregnancy-associated CD.
Conclusions:
- Over a quarter of reproductive-age women with CD had onset within 1 year postpartum.
- Pregnancy-related stress may trigger pituitary corticotroph hyperactivity, suggesting a causal link.
- Heightened clinical suspicion and biochemical testing for CD post-childbirth are recommended.