Management of Cushing's Disease in Pregnancy: A Case Report

Cushing's syndrome (CS) is a rare condition encountered in pregnancy, and Cushing's disease (pituitary-dependent CS) represents an even smaller subset. The occurrence of pregnancy in women with CS is uncommon because hypercortisolism suppresses the hypothalamic-pituitary-gonadal axis, frequently leading to anovulation and infertility. When conception does occur, Cushing's disease can significantly complicate the course of pregnancy, posing serious risks to both the mother and fetus. Reported maternal complications include hypertension, gestational diabetes mellitus, pre-eclampsia, heart failure, and increased susceptibility to infections, while fetal complications include growth restriction, preterm birth, and intrauterine demise. We present a case of a 33-year-old woman with a long history of non-specific symptoms, later confirmed to be due to Cushing's disease secondary to a pituitary microadenoma. Remarkably, she conceived spontaneously before undergoing definitive therapy. Throughout pregnancy, she was managed conservatively under close multidisciplinary supervision, involving endocrinology, obstetrics, and neonatology teams. The optimal management of CS during pregnancy remains controversial, as therapeutic decisions must balance the risks of uncontrolled hypercortisolism against the potential harms of surgical or medical interventions during gestation. In this case, given the stability of maternal and fetal status, a conservative approach was chosen. Despite the challenges posed by physiological changes in pregnancy and the elevated risks associated with CS, the patient's pregnancy progressed without major complications. She ultimately delivered a healthy term infant via planned elective cesarean section. This case highlights the critical importance of individualized, patient-centered care and reinforces the value of multidisciplinary collaboration in managing such high-risk pregnancies. It also suggests that, in carefully selected patients, conservative management can be a safe and effective strategy, leading to favorable maternal and neonatal outcomes.