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Special Aspects of Cushing’s Syndrome: Pregnancy

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Cushing's Syndrome

Part of the book series: Contemporary Endocrinology ((COE))

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Summary

Cushing’s syndrome (CS) is rare during pregnancy because it is associated with infertility in approximately 71% of female patients who have the disease. The diagnosis of CS is challenging in the nonpregnant state and even more so during pregnancy for several reasons. First, pregnant women without CS develop some features of Cushing’s, such as hypertension, hyperglycemia, and striae. Second, the various yet normal functional alterations involving the hypothalamic-pituitary axis during pregnancy make it difficult to use the standard testing normal ranges that are used to diagnose Cushing’s in nonpregnant states (e.g., low-dose dexamethasone suppression testing and assessment of 24-h urinary free cortisol and salivary cortisol). However, because hypercortisolism is associated with unfavorable maternal and fetal outcomes, it is important to have a high index of suspicion of the disease to prevent delay in diagnosis. In this chapter, we explore the different causes of CS during pregnancy, as well as the normal changes affecting the hypothalamic-pituitary-adrenal (HPA) axis and how to incorporate that information into the interpretation of biochemical testing data. We propose a general approach to treatment with both medical and surgical options, while keeping in mind the paramount importance of individualizing therapy.

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Authors and Affiliations

  1. Division of Clinical and Molecular Endocrinology, Department of Medicine, Case Western Reserve, University School of Medicine and VA Health Services Research & Development, Center for Quality Improvement Research, Louis Stokes Cleveland VAMC, Cleveland, OH, USA

    Dima Abdelmannan MD & David C. Aron MD/MS

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  1. Dima Abdelmannan MD
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  2. David C. Aron MD/MS
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  1. , Division of Endocrinology and Metabolism, Hospital das Clínicas, University of Sao, Sao Paulo, 05403-000, Brazil

    Marcello D. Bronstein

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Abdelmannan, D., Aron, D.C. (2010). Special Aspects of Cushing’s Syndrome: Pregnancy. In: Bronstein, M. (eds) Cushing's Syndrome. Contemporary Endocrinology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-449-4_21

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  • DOI: https://doi.org/10.1007/978-1-60327-449-4_21

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