Three Successful Pregnancies in a Patient with Recurrent Cushing's Disease

Area of Science:

• Endocrinology
• Reproductive Medicine
• Neurosurgery

Background:

• Cushing's disease (CD) is a rare condition, particularly during pregnancy.
• It involves excess cortisol production, often due to pituitary adenomas.
• CD can cause infertility and hypogonadotropic hypogonadism.

Observation:

• A 28-year-old woman with diagnosed CD and hypogonadotropic hypogonadism underwent successful surgery for a pituitary macroadenoma.
• She achieved initial remission, restored fertility, and had two uncomplicated pregnancies.
• A third pregnancy occurred 5 years later, with recurrent CD manifesting as mild hypercortisolism.

Findings:

• The recurrent CD during the third pregnancy was managed expectantly due to mild symptoms.
• This conservative approach resulted in a healthy full-term infant.
• No maternal complications were noted during pregnancy or labor.

Implications:

• This case underscores the challenges in managing active Cushing's disease during pregnancy.
• It suggests that a conservative, expectant approach may be viable for mild cases.
• Postponing specific treatment until after delivery can be a safe option when maternal and fetal risks are low.