Diagnosis and Treatment of High-risk Pregnant Women With Cushing Syndrome Caused by Adrenal Tumor
Juping Zhao, MD, PhD, Parehe Alimu, MD, Jun Dai, MD, Jing Xie, MD, Danfeng Xu, MD, PhD, Fukang Sun, MD, PhD
Department of Urology, Shanghai JiaoTong University School of Medicine, Ruijin Hospital, Shanghai, China (all authors).
ABSTRACT
Introduction: The occurrence of pregnancy with Cushing syndrome (CS) is rare but with high risks, posing a great challenge to the clinical diagnosis and treatment of the disease.
Case Description: From Aug 2016 to Aug 2019, we admitted two pregnant women with CS caused by adrenal tumors. After multidisciplinary consultation, they underwent emergency Cesarean section because of heart failure and severe hypoxemia, and finally delivered a living baby after adjuvant therapy. Both patients underwent retroperitoneal laparoscopic adrenectomy (RLA) 2.6 and 1.5 months postpartum to have the adrenal tumors removed successfully. The post- operative pathology confirmed the adrenal tumor as adrenocortical adenoma. Partial hormone replacement therapy was initiated postoperatively and withdrawn uneventfully 1 year after RLA in both patients, and both patients have recovered well.
Conclusion: It is difficult to find CS in early pregnancy, and when it is detected in late pregnancy, it often poses a great risk because it is necessary to consider the safety of both mother and fetus, which requires multidisciplinary coordination and cooperation to positively adjust the cardiopulmonary function and internal environment after Cesarean section, knowing that timely RLA to remove the adrenocortical adenoma can effectively cure CS.
Key Words: Pregnancy, Cushing syndrome, Adrenal tumor, Heart failure, Hypertension.
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