Endogenous Cushing's syndrome during pregnancy

Area of Science:

• Endocrinology
• Reproductive Medicine
• Obstetrics

Background:

• Endogenous Cushing's syndrome (CS) is uncommon in pregnancy, often linked to infertility caused by hypercortisolism.
• Primary adrenal causes, including adrenal adenomas and pregnancy-induced CS (secondary to LHCGR aberrant expression), are the most frequent etiologies.

Purpose of the Study:

• To review the diagnosis and management of endogenous Cushing's syndrome during pregnancy.
• To highlight the diagnostic challenges and optimal treatment strategies for maternal and fetal well-being.

Main Methods:

• Literature review of endogenous Cushing's syndrome in pregnancy.
• Analysis of diagnostic criteria and imaging limitations in pregnant patients.
• Evaluation of surgical and non-surgical management approaches and their outcomes.

Main Results:

• Diagnosis is complicated by physiological hypercortisolism; specialized interpretation of cortisol tests and high clinical suspicion are crucial.
• Imaging modalities are limited due to radiation and teratogenicity concerns.
• Surgical resection of adrenal or pituitary adenomas before 24 weeks gestation is optimal; delayed surgery or conservative management focuses on metabolic control.

Conclusions:

• Early diagnosis and timely surgical intervention are key for managing Cushing's syndrome in pregnancy.
• While treatment can improve outcomes, maternal and fetal complications persist, with fetal loss being a notable exception.
• Management requires a multidisciplinary approach considering both maternal and fetal health.