ACTH-DEPENDENT CUSHING'S SYNDROME IN PREGNANCY

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 163-194-Pituitary Disorders & Case Reports
Basic/Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-179
Lea Juárez-Allen*1, Reynaldo Manuel Gomez2, Carolina Urciuoli1, Silvana Politi1, Jorge Herrera1, Marcos Manavela3 and Oscar Domingo Bruno4
1Hospital de Clínicas, Buenos Aires, Argentina, 2Hosp de Clinicas, Buenos Aires, Argentina, 3Hospital de Clínicas, Argentina, 4Estudios Metabólicos y Endocrino, Buenos Aires, Argentina
Cushing´s syndrome (CS) is associated with high incidence of ovulatory dysfunction and pregnancy is uncommon in untreated patients. Nearly 150 well documented cases have been reported and adrenal adenomas have been found to be the most common cause. CS during pregnancy is frequently associated with severe maternal and fetal complications and its management is critical. Nevertheless, follow-up and treatment are still controversial.

We describe here the evolution and management of pregnancy in 5 patients with previous diagnosis of ACTH-dependent CS (A-CS).

Two hundred and thirty nine premenopausal women with CS were assisted between 1998 and 2011, 5 patients out of 203 with A-CS became pregnant but none of 36 ACTH independent CS.

Age at diagnosis was 21-26 and at pregnancy 25-35 y-o. Patient 1 became pregnant during her assessment and realized her condition after 6 months of amenorrhea. Patients 2 to 4 had histopathological confirmation of Cushing´s disease and 2 of them were under ketoconazole treatment. Patient 5 had Nelson´s syndrome (ACTH > 6000 pg/ml) with an evident corticotropinoma in MRI and was under hydrocortisone and betamethasone. All but one pregnancy were achieved spontaneously. Twenty four-UFC were 97-254 and their highest values during pregnancy reached 96-1372 µg.  Only one patient received KTZ during the 2° trimester because of refractory hypertension and gestational diabetes. Three patients delivered a healthy full-term infant, one via vaginal delivery, and two via cesarean section, without complications. One had a preterm but healthy baby via cesarean section and patient 1 had a stillbirth at week 33.

Because pregnancy during CS is associated with severe maternal and fetal complications, early treatment is critical and must be considered for each case, depending on the etiology, severity of the disease and the time of gestation. Surgery is treatment of choice for CS in pregnancy in the first and second trimester. Other alternatives include conservative management, treatment of complications, or pharmacological therapy. In our experience, careful observation and monitoring of patients allowed us to keep a conservative treatment that, in the majority of cases, resulted in pregnancies without complications and healthy newborns. In contrast to previous publications, our group was mainly formed by A-CS pregnant patients.

Nothing to Disclose: LJ, RMG, CU, SP, JH, MM, ODB

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm