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A Pregnant Woman Who Underwent Laparoscopic Adrenalectomy due to Cushing's Syndrome.

Diri H, Bayram F, Simsek Y, Ozkan Y, Akcan A, Karahan I, Ileri I, Aribas S, Koc MS - Case Rep Endocrinol (2014)

Bottom Line: MRI showed a 3.5 cm adenoma in her right adrenal gland.Although she had a temporary postoperative adrenal insufficiency, hormonal analyses showed that she has been in remission since delivery.Rather, such surgery should be considered a safe and efficient treatment method for pregnant women with cortisol-secreting adrenal adenomas.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology, Erciyes University Medical School, 38039 Kayseri, Turkey.

ABSTRACT
Cushing's syndrome (CS) may lead to severe maternal and fetal morbidities and even mortalities in pregnancy. However, pregnancy complicates the diagnosis and treatment of CS. This study describes a 26-year-old pregnant woman admitted with hypertension-induced headache. Hormonal analyses performed due to her cushingoid phenotype revealed a diagnosis of adrenocorticotropic hormone- (ACTH-) independent CS. MRI showed a 3.5 cm adenoma in her right adrenal gland. After preoperative metyrapone therapy, she underwent a successful unilateral laparoscopic adrenalectomy at 14-week gestation. Although she had a temporary postoperative adrenal insufficiency, hormonal analyses showed that she has been in remission since delivery. Findings in this patient, as well as those in previous patients, indicate that pregnancy is not an absolute contraindication for laparoscopic adrenalectomy. Rather, such surgery should be considered a safe and efficient treatment method for pregnant women with cortisol-secreting adrenal adenomas.

No MeSH data available.


Related in: MedlinePlus

MR image of the adrenal adenoma and intrauterine fetus.
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fig1: MR image of the adrenal adenoma and intrauterine fetus.

Mentions: Firstly, she was treated with methyldopa to control her hypertension. Complete blood count and biochemistry tests including plasma glucose, liver and renal functions, and electrolytes were normal. Fetal ultrasound imaging was also normal and intrauterine growth restriction was not reported. Subsequent hormonal analyses showed a serum cortisol concentration of 48.2 μg/dL after a 2 mg low dose-dexamethasone suppression test (LD-DST), a midnight serum cortisol concentration while awake of 32.0 μg/dL, and a urine free cortisol (UFC) concentration of 2358 μg/24 h (normal: 55–280 μg/24 h). In addition, baseline serum cortisol and ACTH concentrations were 44.4 μg/dL and 4.08 pg/mL, respectively, and serum cortisol concentration after 8 mg high dose-DST was 48.7 μg/dL. The patient was diagnosed with ACTH-independent CS, and the diagnosis was confirmed by magnetic resonance imaging, which showed a 3.5 × 2.5 cm adenoma in her right adrenal gland (Figure 1).


A Pregnant Woman Who Underwent Laparoscopic Adrenalectomy due to Cushing's Syndrome.

Diri H, Bayram F, Simsek Y, Ozkan Y, Akcan A, Karahan I, Ileri I, Aribas S, Koc MS - Case Rep Endocrinol (2014)

MR image of the adrenal adenoma and intrauterine fetus.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4269281&req=5

fig1: MR image of the adrenal adenoma and intrauterine fetus.
Mentions: Firstly, she was treated with methyldopa to control her hypertension. Complete blood count and biochemistry tests including plasma glucose, liver and renal functions, and electrolytes were normal. Fetal ultrasound imaging was also normal and intrauterine growth restriction was not reported. Subsequent hormonal analyses showed a serum cortisol concentration of 48.2 μg/dL after a 2 mg low dose-dexamethasone suppression test (LD-DST), a midnight serum cortisol concentration while awake of 32.0 μg/dL, and a urine free cortisol (UFC) concentration of 2358 μg/24 h (normal: 55–280 μg/24 h). In addition, baseline serum cortisol and ACTH concentrations were 44.4 μg/dL and 4.08 pg/mL, respectively, and serum cortisol concentration after 8 mg high dose-DST was 48.7 μg/dL. The patient was diagnosed with ACTH-independent CS, and the diagnosis was confirmed by magnetic resonance imaging, which showed a 3.5 × 2.5 cm adenoma in her right adrenal gland (Figure 1).

Bottom Line: MRI showed a 3.5 cm adenoma in her right adrenal gland.Although she had a temporary postoperative adrenal insufficiency, hormonal analyses showed that she has been in remission since delivery.Rather, such surgery should be considered a safe and efficient treatment method for pregnant women with cortisol-secreting adrenal adenomas.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology, Erciyes University Medical School, 38039 Kayseri, Turkey.

ABSTRACT
Cushing's syndrome (CS) may lead to severe maternal and fetal morbidities and even mortalities in pregnancy. However, pregnancy complicates the diagnosis and treatment of CS. This study describes a 26-year-old pregnant woman admitted with hypertension-induced headache. Hormonal analyses performed due to her cushingoid phenotype revealed a diagnosis of adrenocorticotropic hormone- (ACTH-) independent CS. MRI showed a 3.5 cm adenoma in her right adrenal gland. After preoperative metyrapone therapy, she underwent a successful unilateral laparoscopic adrenalectomy at 14-week gestation. Although she had a temporary postoperative adrenal insufficiency, hormonal analyses showed that she has been in remission since delivery. Findings in this patient, as well as those in previous patients, indicate that pregnancy is not an absolute contraindication for laparoscopic adrenalectomy. Rather, such surgery should be considered a safe and efficient treatment method for pregnant women with cortisol-secreting adrenal adenomas.

No MeSH data available.


Related in: MedlinePlus