Hypercortisolism and pregnancy

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In this study we retrospectively analyzed data from 221 autopsy protocols of maternal mortality 1996-2015 years. Pathology of adrenal cortex detected in 11 dead. Microadenoma with or without adenomatous hyperplasia of adrenal cortex detected in 8 dead, simple hyperplasia detected in 3 dead. In one case detected bilateral diffuse nodular hyperplasia adrenal cortex in combination with focal adenomatous hyperplasia basophil adenocytes pituitary. In this article presented the background pathology analysis, course and outcomes of the last pregnancy. The conclusion was that the microadenomas of adrenal cortex rarely remain asymptomatic incidentalomas, but more often occur the subclinical or clinical hypercortisolism. The pregnancy on their background carries a high risk of developing of serious complications.

Margarita A. Repina

Author for correspondence.
North-Western State Medical University named after I.I. Mechnikov
Russian Federation, 41, Kirochnaya street, Saint-Petersburg, 191015


  • Aron DC, Schnall AM, Sheeler LR. Cushing’s syndrome and pregnancy. Am J Obstet Gynecol. 1990;162: 244-9. doi: 10.1016/0002-9378(90)90859-6.
  • Buescher MA. Cushing’s syndrome in pregnancy. Endocrinologist. 1996;6:357-62. doi: 10.1097/00019616-199609000-00002.
  • Lindsay JR, Nieman LK. The hypothalamic-pituitary-adrenal axis in pregnancy. Endocrin Rev. 2005;26:755-99. doi: 10.1210/er.2004-0025.
  • Nassi R, Ladu C, Vezzosi Ch, Manelli M. Cushing’s syndrome in pregnancy. Gynecol Endocrinol. 2015;31:102-4. doi: 10.3109/09513590.2014.984680.
  • Carpenter PC. Diagnostic evaluation of Cushing’s syndrome. Endocrinol Metab Clin North Am. 1988;17:445-51.
  • Lado-Abeal J, Rodriguez-Amao J, Newell-Price JD, et al. Menstrual abnormalities in women with Cushing’s disease are correlated with hypercortisolemia rather than raised circulating androgen levels. J Clin Endocrinol Metab.1998;83:3083-6.
  • Tauchmanova L, Pivonello R, Di Somma C, et al. Bone demineralization and vertebral fractures in endogenous cortisol excess. J Clin Endocrinol Metab. 2006;91(15):1779-84. doi: 10.1210/jc.2005–0582.
  • Hadden DR. Adrenal disorders of pregnancy. Endocrinol Metab Clin North Am. 1995;24:139-45.
  • Lindsay JR, Jonklaas J, Oldfield EH, Nieman LK. Cushing’s syndrome during pregnancy: personal experience and review of the literature. J Clin Endocrinol Metab. 2005;90(5):3077-83. doi: 10.1210/jc.2004-2361.
  • Pricolo VE, Monchik JM, Prinz RA, et al. Management of Cushing’s syndrome secondary to adenoma during pregnancy. Surgery.1990;108(6):1072-7.
  • Bronstein MD, Paraiba DB, Jallad RS. Management of pituitary tumors in pregnancy. Nat Rev Endocrinol. 2011;7(5):301-10. doi: 10.1038/nrendo.2011.38.
  • Gormley MJ, Hadden DR, Kennedy TL, et al. Cushing’s syndrome in pregnancy — treatment with metyrapone. Clin Endocrinol. 1982;16:283-93. doi: 10.1111/j.1365-2265.1982.tb00718.x.
  • Close CF, Mann MC, Watts JF, et al. ACTH-independent Cushing’s syndrome in pregnancy with spontaneous resolution after delivery: control of the hypercortisolism with metyrapone. Clin Endocrinol. 1993;39:375-9. doi: 10.1111/j.1365-2265.1993.tb02380.x.
  • Blanco C, Maqueda E, Rubio JA, Rodriguez A. Cushing’s syndrome during pregnancy secondary to adrenal adenoma: metyrapone treatment and laparoscopic adrenalectomy. J Endocrinol Invest. 2006;29:164-7. doi: 10.1007/BF03344091.
  • Connell JM, Cordiner J, Davies DL, et al. Pregnancy complicated by Cushing’s syndrome potential hazard of metyrapone therapy. Brit J Obst Gynecol. 1985;92(11):1192-5. doi: 10.1111/j.1471-0528.1985.tb03037.x.
  • Hana V, Dokoupilova M, Marek J, et al. Recurrent ACTH-independent Cushing’s syndrome in multiple pregnancies and its treatment with metyrapone. Clin Endocrinol. 2001;54:277-81. doi: 10.1046/j.1365-2265.2001.01055.x.
  • Nieman LK. Establishing the diagnosis of Cushing’s syndrome. UpToDate. 2016 Available at: http://www.uptodate.com/contents/treatment-of-hemophilia/abstract/151.


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