A Rare Occurrence of Premature Birth and Recurrent Acute Pulmonary Oedema in the Mother due to Cushing’s Syndrome
A Case Report
Presentation of Cushing’s syndrome during pregnancy is extremely rare. We report a 21-year-old female with Cushing’s syndrome diagnosed at 23 weeks of gestation and had recurrent acute pulmonary oedema during the antepartum and postpartum period. She delivered prematurely via emergency caesarean section at 28 weeks of gestation. This case highlights the rare occurrence of recurrent acute pulmonary oedema during pregnancy and consequential premature birth in a patient with adrenal Cushing’s. She was diagnosed with adrenal Cushing’s during the postpartum period based on unsuppressed serum cortisol after overnight and low-dose dexamethasone suppression test with a suppressed ACTH. CT scan of the adrenal glands revealed a right adrenal cortical adenoma. The risk of complications in infants and mothers who suffer from Cushing’s syndrome needs to be handled carefully. The diagnosis of Cushing’s syndrome in pregnant women often overlaps and is difficult to establish in early pregnancy.
Caimari F, Valassi E, Garbayo P, et al. Cushing’s syndrome and pregnancy outcomes: A systematic review of published cases. Endocrine. 2017;55(2):555–63. https://pubmed.ncbi.nlm.nih.gov/27704478. https://doi.org/10.1007/s12020-016-1117-0.
Machado MC, Fragoso MCBV, Bronstein MD. Pregnancy in patients with Cushing’s syndrome. Endocrinol Metab Clin North Am. 2018; 47(2):441-9. PMID: 29754643. https://pubmed.ncbi.nlm.nih.gov/
Brue T, Amodru V, Castinetti F. Management of endocrine diseases: Management of Cushing’s syndrome during pregnancy: Solved and unsolved questions. Eur J Endocrinol. 2018;178(6):R259-66. https://pubmed.ncbi.nlm.nih.gov/29523633. https://doi.org/10.1530/EJE-17-1058.
Lindsay JR, Nieman LK. The hypothalamic-pituitary-adrenal axis in pregnancy: Challenges in disease detection and treatment. Endocr Rev. 2005;26(6):775–99. https://pubmed.ncbi.nlm.nih.gov/15827110. https://doi.org/10.1210/er.2004-0025.
Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of Cushing’s syndrome: A consensus statement. J Clin Endocrinol Metab. 2003;88(12):5593-602. https://doi.org/10.1210/jc.2003-030871.
Johnston PC, Atkinson AB, Moore MJ, et al. An unusual cause of reversible cardiomyopathy. Ulster Med J. 2012;81(3):134–5. https://pubmed.ncbi.nlm.nih.gov/23620612. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632823.
Choi WJ, Jung TS, Paik WY. Cushing’s syndrome in pregnancy with a severe maternal complication: A case report. J Obstet Gynaecol Res. 2011; 37(2):163–7. https://pubmed.ncbi.nlm.nih.gov/21159041. https://doi.org/10.1111/j.1447-0756.2010.01339.x.
Kamenický P, Redheuil A, Roux C, et al. Cardiac structure and function in Cushing’s syndrome: A cardiac magnetic resonance imaging study. J Clin Endocrinol Metab. 2014;99(11):E2144–53. https://pubmed.ncbi.nlm.nih.gov/25093618. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4223435. https://doi.org/10.1210/jc.2014-1783.
Andreescu CE, Alwani RA, Hofland J, et al. Adrenal Cushing’s syndrome during pregnancy. Eur J Endocrinol. 2017:177(5): K13-20. https://pubmed.ncbi.nlm.nih.gov/28819015. https;//doi.org/10.1530/EJE-17-0263.
Copyright (c) 2021 Dorothy Maria A/p Anthony Bernard, Ooi Xin Yi, Hema Lata A/p Veerasamy, Mohamed Badrulnizam Long Bidin, See Chee Keong
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to email@example.com or firstname.lastname@example.org.
A written agreement shall be emailed to the requester should permission be granted.