The diagnosis and management of Cushing's syndrome in pregnancy.
Cushing's syndrome; pregnancy
adrenal adenoma
hypercortisolism
pituitary tumour
Journal
Journal of neuroendocrinology
ISSN: 1365-2826
Titre abrégé: J Neuroendocrinol
Pays: United States
ID NLM: 8913461
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
revised:
01
03
2022
received:
13
02
2022
accepted:
05
03
2022
pubmed:
2
5
2022
medline:
15
9
2022
entrez:
1
5
2022
Statut:
ppublish
Résumé
Endogenous Cushing's syndrome (CS) is rarely encountered during pregnancy. Clinical and biochemical changes in healthy pregnancy overlap with those seen in pregnancy complicated by CS; the diagnosis is therefore challenging and can be delayed. During normal gestation, adrenocorticotrophic hormone, corticotrophin-releasing hormone, cortisol, and urinary free cortisol levels rise. Dexamethasone administration fails to fully suppress cortisol in pregnant women without CS. Localisation may be hindered by non-suppressed adrenocorticotrophic hormone levels in a large proportion of those with adrenal CS; smaller corticotroph adenomas may go undetected as a result of a lack of contrast administration or the presence of pituitary hyperplasia; and inferior petrosal sinus sampling is not recommended given the risk of radiation and thrombosis. Yet, diagnosis is essential; active disease is associated with multiple insults to both maternal and foetal health, and those cured may normalise the risk of maternal-foetal complications. The published literature consists mostly of case reports or small case series affected by publication bias, heterogeneous definitions of maternal or foetal outcomes or lack of detail on severity of hypercortisolism. Consequently, conclusive recommendations, or a standardised management approach for all, cannot be made. Management is highly individualised: the decision for surgery, medical control of hypercortisolism or adoption of a conservative approach is dependent on the timing of diagnosis (respective to stage of gestation), the ability to localise the tumour, severity of CS, pre-existing maternal comorbidity, and, ultimately, patient choice. Close communication is a necessity with the patient placed at the centre of all decisions, with risks, benefits, and uncertainties around any investigation and management carefully discussed. Care should be delivered by an experienced, multidisciplinary team, with the resources and expertise available to manage such a rare and challenging condition during pregnancy.
Identifiants
pubmed: 35491087
doi: 10.1111/jne.13118
pmc: PMC9541401
doi:
Substances chimiques
Adrenocorticotropic Hormone
9002-60-2
Hydrocortisone
WI4X0X7BPJ
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13118Informations de copyright
© 2022 The Authors. Journal of Neuroendocrinology published by John Wiley & Sons Ltd on behalf of British Society for Neuroendocrinology.
Références
Ann R Coll Surg Engl. 2019 Jan;101(1):e26-e31
pubmed: 30286651
Pituitary. 2020 Apr;23(2):189-199
pubmed: 31691893
J Endocrinol Invest. 2006 Feb;29(2):164-7
pubmed: 16610244
J Clin Endocrinol Metab. 2015 Nov;100(11):4146-54
pubmed: 26353009
Lancet Diabetes Endocrinol. 2019 Apr;7(4):300-312
pubmed: 30033041
Eur J Endocrinol. 2015 Jun;172(6):R263-80
pubmed: 25637072
AACE Clin Case Rep. 2021 Nov 26;8(3):105-108
pubmed: 35602876
Br J Anaesth. 1998 Jun;80(6):850-2
pubmed: 9771323
Eur J Obstet Gynecol Reprod Biol. 1982 Sep;13(6):343-7
pubmed: 7128894
J Clin Endocrinol Metab. 2011 Apr;96(4):E658-62
pubmed: 21289243
BMC Endocr Disord. 2020 May 11;20(1):62
pubmed: 32393232
J Endocrinol Invest. 2009 Apr;32(4):313-6
pubmed: 19636197
Clin Endocrinol (Oxf). 1987 Oct;27(4):423-8
pubmed: 3325196
J Clin Endocrinol Metab. 2021 Jun 16;106(7):2114-2123
pubmed: 33675650
Obstet Gynecol. 2017 Oct;130(4):e210-e216
pubmed: 28937575
Endocrinol Metab Clin North Am. 2018 Jun;47(2):441-449
pubmed: 29754643
J Neuroendocrinol. 2022 Aug;34(8):e13134
pubmed: 35980263
Eur J Endocrinol. 2001 Feb;144(2):117-21
pubmed: 11182747
Obstet Gynecol. 2014 Aug;124(2 Pt 2 Suppl 1):426-428
pubmed: 25004313
Postgrad Med J. 1990 Mar;66(773):221-3
pubmed: 2362890
Reproduction. 2002 Sep;124(3):323-9
pubmed: 12201805
J Soc Gynecol Investig. 1999 May-Jun;6(3):109-19
pubmed: 10376266
Front Endocrinol (Lausanne). 2018 May 01;9:164
pubmed: 29765354
Pituitary. 2015 Apr;18(2):181-7
pubmed: 25571880
J Neuroendocrinol. 2022 Aug;34(8):e13118
pubmed: 35491087
J Neuroendocrinol. 2022 Aug;34(8):e13143
pubmed: 35980242
Endocrinol Jpn. 1988 Oct;35(5):685-90
pubmed: 3220047
J Endocr Soc. 2020 Nov 05;5(1):bvaa167
pubmed: 33305159
Clin Sci (Lond). 1987 Jun;72(6):725-35
pubmed: 3595077
Front Endocrinol (Lausanne). 2020 Dec 08;11:648
pubmed: 33363514
J Neuroendocrinol. 2022 Aug;34(8):e13111
pubmed: 35979805
J Clin Endocrinol Metab. 2008 May;93(5):1526-40
pubmed: 18334580
Psychoneuroendocrinology. 2014 Dec;50:264-73
pubmed: 25247747
J Neuroendocrinol. 2022 Aug;34(8):e13123
pubmed: 35352410
Endocrinol Diabetes Metab Case Rep. 2020 Apr 12;2020:
pubmed: 32478666
J Endocr Soc. 2017 Jan 12;1(1):57-71
pubmed: 29264446
Gynecol Obstet Invest. 2001;51(3):211-3
pubmed: 11306912
Hormones (Athens). 2016 Jul;15(3):453-458
pubmed: 27394707
J Clin Endocrinol Metab. 1996 Jan;81(1):15-21
pubmed: 8550743
N Engl J Med. 1999 Nov 18;341(21):1577-81
pubmed: 10564687
Neurosurgery. 1992 Nov;31(5):953-5; discussion 955
pubmed: 1331848
J Clin Endocrinol Metab. 1993 Jan;76(1):260-2
pubmed: 8421097
Gynecol Endocrinol. 2002 Oct;16(5):413-7
pubmed: 12587537
Endocr J. 2003 Dec;50(6):739-44
pubmed: 14709846
BJOG. 2000 Jun;107(6):810-2
pubmed: 10847243
J Clin Endocrinol Metab. 2003 Jan;88(1):230-7
pubmed: 12519858
Eur J Endocrinol. 2017 Nov;177(5):K13-K20
pubmed: 28819015
Obstet Gynecol. 2013 Aug;122(2 Pt 2):485-487
pubmed: 23884269
J Obstet Gynaecol. 1999 May;19(3):303
pubmed: 15512304
Mayo Clin Proc. 1990 Apr;65(4):461-74
pubmed: 2159093
J Neuroendocrinol. 2022 Aug;34(8):e13172
pubmed: 35726348
J Neuroendocrinol. 2022 Aug;34(8):e13148
pubmed: 35596671
Urol J. 2014 Nov 01;11(5):1911-3
pubmed: 25361714
N Engl J Med. 1981 Oct 8;305(15):893-4
pubmed: 7278892
Clin Imaging. 2020 Jun;62:69-75
pubmed: 32109683
J Clin Endocrinol Metab. 1987 Feb;64(2):224-9
pubmed: 3491832
Eur J Obstet Gynecol Reprod Biol. 2012 Nov;165(1):1-7
pubmed: 22698457
Aust N Z J Obstet Gynaecol. 2012 Feb;52(1):96-100
pubmed: 22188308
Pituitary. 2018 Dec;21(6):631-641
pubmed: 29855779
Eur J Endocrinol. 2021 Mar;184(3):469-476
pubmed: 33486470
Gynecol Endocrinol. 2012 Aug;28(8):637-9
pubmed: 22309603
Hormones (Athens). 2015 Jan-Mar;14(1):70-80
pubmed: 25885105
J Neuroendocrinol. 2022 Aug;34(8):e13142
pubmed: 35980208
Clin Med (Lond). 2019 Sep;19(5):399-402
pubmed: 31530689
Pituitary. 2022 Apr;25(2):267-274
pubmed: 34843070
Eur J Endocrinol. 2018 Jun;178(6):R259-R266
pubmed: 29523633
Pituitary. 2016 Feb;19(1):30-8
pubmed: 26346684
Surg Neurol Int. 2015 Nov 25;6(Suppl 25):S640-5
pubmed: 26682090
Curr Opin Endocrinol Diabetes Obes. 2017 Jun;24(3):184-192
pubmed: 28288009
Lancet Diabetes Endocrinol. 2021 Dec;9(12):847-875
pubmed: 34687601
Am J Obstet Gynecol. 1981 Feb 15;139(4):416-22
pubmed: 6258436
Neuroendocrinology. 2013;98(2):106-15
pubmed: 23969897
Am J Obstet Gynecol. 1994 Aug;171(2):563-4
pubmed: 8059845
J Matern Fetal Neonatal Med. 2021 Aug 29;:1-7
pubmed: 34459316
J Neuroendocrinol. 2022 Aug;34(8):e13175
pubmed: 35764311
Eur J Endocrinol. 2021 Aug 23;185(3):G1-G33
pubmed: 34425558
J Clin Endocrinol Metab. 2011 May;96(5):1533-40
pubmed: 21367926
Clin Endocrinol (Oxf). 2007 Jun;66(6):869-77
pubmed: 17437519
Fertil Steril. 1999 Aug;72(2):371-2
pubmed: 10439015
J Clin Endocrinol Metab. 1993 Aug;77(2):494-7
pubmed: 8345057
Eur J Endocrinol. 1995 Jun;132(6):722-6
pubmed: 7788013
Endocrinol Metab Clin North Am. 2019 Sep;48(3):569-581
pubmed: 31345524
J Neuroendocrinol. 2022 Aug;34(8):e13169
pubmed: 35979732
Onkologie. 2011;34(1-2):46-9
pubmed: 21346385
J Neuroendocrinol. 2022 Aug;34(8):e13137
pubmed: 35980277
Pituitary. 2021 Oct;24(5):670-680
pubmed: 33779937
J Clin Endocrinol Metab. 2005 May;90(5):3077-83
pubmed: 15705919
J Neuroendocrinol. 2022 Aug;34(8):e13167
pubmed: 35980249
Presse Med. 2014 Apr;43(4 Pt 1):376-92
pubmed: 24656295
Endocrine. 2017 Feb;55(2):555-563
pubmed: 27704478
J Neuroendocrinol. 2022 Aug;34(8):e13177
pubmed: 35980172
Endocrinol Diabetes Metab Case Rep. 2019 Feb 7;2019:
pubmed: 30738017
Br J Obstet Gynaecol. 1980 Dec;87(12):1171-3
pubmed: 7437385
Gynecol Endocrinol. 2011 Sep;27(9):675-7
pubmed: 20923280
Gynecol Endocrinol. 1999 Jun;13(3):175-82
pubmed: 10451809
J Neuroendocrinol. 2022 Aug;34(8):e13114
pubmed: 35979717
J Endocrinol Invest. 2016 Mar;39(3):273-6
pubmed: 26202044
J Clin Endocrinol Metab. 2011 Nov;96(11):3525-32
pubmed: 21880802
J Clin Endocrinol Metab. 2013 Feb;98(2):443-7
pubmed: 23275528
Ann Endocrinol (Paris). 1989;50(1):49-53
pubmed: 2729882
Rev Med Chil. 2004 Jan;132(1):75-80
pubmed: 15379057
Horm Metab Res. 1989 Oct;21(10):566-72
pubmed: 2553573
Clin Endocrinol (Oxf). 1991 Aug;35(2):169-78
pubmed: 1657460
Gynecol Endocrinol. 2017 May;33(5):349-352
pubmed: 28277127
J Neuroendocrinol. 2022 Aug;34(8):e13113
pubmed: 35312199
Eur J Endocrinol. 2015 Aug;173(2):R85-91
pubmed: 25872515
Pituitary. 2018 Apr;21(2):162-167
pubmed: 29280025
Endocr Rev. 2005 Oct;26(6):775-99
pubmed: 15827110
Eur J Obstet Gynecol Reprod Biol. 2013 May;168(1):1-6
pubmed: 23305861
J Neuroendocrinol. 2022 Aug;34(8):e13147
pubmed: 35524583
BMJ Case Rep. 2017 Jul 14;2017:
pubmed: 28710189
J Clin Endocrinol Metab. 1977 Jun;44(6):1214-7
pubmed: 874053
J Physiol Biochem. 2013 Sep;69(3):559-73
pubmed: 23385670
Horm Res. 2004;62(6):300-5
pubmed: 15557761
Am J Obstet Gynecol. 1986 Mar;154(3):626-8
pubmed: 3953709
Life Sci. 1987 Oct 5;41(14):1745-50
pubmed: 3657381
Gynecol Endocrinol. 2015 Mar;31(3):176-8
pubmed: 25561184
J Neuroendocrinol. 2022 Aug;34(8):e13120
pubmed: 35348261
Best Pract Res Clin Endocrinol Metab. 2021 Jan;35(1):101521
pubmed: 33766428
Eur J Endocrinol. 2010 Nov;163(5):793-800
pubmed: 20699382
J Neuroendocrinol. 2022 Aug;34(8):e13186
pubmed: 35979714
Gynecol Endocrinol. 2013 Apr;29(4):309-10
pubmed: 23323736
Clin Endocrinol (Oxf). 2001 Feb;54(2):277-81
pubmed: 11207645
Am J Obstet Gynecol. 1983 Feb 15;145(4):411-6
pubmed: 6297302
J Clin Endocrinol Metab. 2021 Jan 1;106(1):16-25
pubmed: 33118025
Clin Endocrinol (Oxf). 1990 Jul;33(1):99-106
pubmed: 2169361