Citation: BJOG: An International Journal of Obstetrics and Gynaecology. 2013, 120, 125
Author: Mohammed R.O.; Mwenechanya S.; Khoo C.
Abstract: Introduction Pregnancy occurring in women with Cushing's syndrome is rare as high cortisol levels make conception unlikely. Pregnancy occurring in pituitary driven Cushing's disease is even rarer with only just over 70 cases described in the English literature. Hypercortisolism is associated with increased maternal morbidity and adverse fetal outcome especially if untreated. We report on a rare case of a successful pregnancy with a live birth in a case of untreated pituitary driven Cushing's disease. Case Report A 38-year-old gravida 5 para 3 woman with Cushing's disease and a 5 mm micro adenoma on MRI was awaiting treatment when she got pregnant. Although she had Cushing's disease for about 5 years she had declined treatment and was poorly controlled and had obesity, osteoporosis causing necrosis of femoral head and recurrent infections on the fat pad at back of neck. She declined surgical and medical management during pregnancy. She persisted with hypercortisolism throughout the pregnancy and clinically worsened with increased obesity, recurrent abscesses in her buffalo hump, worsening back pain from osteoporosis and was wheelchair bound from the necrosis of neck of femur. In spite of the untreated hypercortisolism, the pregnancy progressed to 33 weeks of gestation. She then went into spontaneous labour and had a live vaginal delivery of a male infant. There were no intrapartum or postnatal complications for both mother and baby. Discussion Untreated hypercortisolism is associated with increased maternal morbidity like
hypertension, cardiac failure, gestational diabetes, poor skin healing and recurrent infections as well as poor fetal outcomes like still births and preterm labour. Pregnancy outcome may be improved in patients who have surgery to remove the pituitary tumour. Although medical treatment with cortisol inhibiting drugs like ketoconazole and metyrapone have been reported in pregnancy the results have been conflicting with some
case reports reporting high fetal loss rates. There are very few reported cases in the literature of successful pregnancies in untreated Cushing's disease. Our patient gave birth to a live male infant despite lack of treatment. This case highlights the rare occurrence of a successful pregnancy in Cushing's disease and a favourable outcome with supportive measures only.
