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

      case-report

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          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.

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          Most cited references32

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          Cushing's syndrome.

          Cushing's syndrome results from lengthy and inappropriate exposure to excessive glucocorticoids. Untreated, it has significant morbidity and mortality. The syndrome remains a challenge to diagnose and manage. Here, we review the current understanding of pathogenesis, clinical features, diagnostic, and differential diagnostic approaches. We provide diagnostic algorithms and recommendations for management.
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            The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states.

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              The hypothalamic-pituitary-adrenal axis in pregnancy: challenges in disease detection and treatment.

              Pregnancy dramatically affects the hypothalamic-pituitary-adrenal axis leading to increased circulating cortisol and ACTH levels during gestation, reaching values in the range seen in Cushing's syndrome (CS). The cause(s) of increased ACTH may include placental synthesis and release of biologically active CRH and ACTH, pituitary desensitization to cortisol feedback, or enhanced pituitary responses to corticotropin-releasing factors. In this context, challenges in diagnosis and management of disorders of the hypothalamic-pituitary-adrenal axis in pregnancy are discussed. CS in pregnancy is uncommon and is associated with fetal morbidity and mortality. The diagnosis may be missed because of overlapping clinical and biochemical features in pregnancy. The proportion of patients with primary adrenal causes of CS is increased in pregnancy. CRH stimulation testing and inferior petrosal sinus sampling can identify patients with Cushing's disease. Surgery is a safe option for treatment in the second trimester; otherwise medical therapy may be used. Women with known adrenal insufficiency that is appropriately treated can expect to have uneventful pregnancies. Whereas a fetal/placental source of cortisol may mitigate crisis during gestation, unrecognized adrenal insufficiency may lead to maternal or fetal demise either during gestation or in the puerperium. Appropriate treatment and management of labor are reviewed.
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                Author and article information

                Journal
                Case Rep Endocrinol
                Case Rep Endocrinol
                CRIE
                Case Reports in Endocrinology
                Hindawi Publishing Corporation
                2090-6501
                2090-651X
                2014
                3 December 2014
                : 2014
                : 283458
                Affiliations
                1Division of Endocrinology, Erciyes University Medical School, 38039 Kayseri, Turkey
                2Division of Endocrinology, Firat University Medical School, 23000 Elazığ, Turkey
                3Department of General Surgery, Erciyes University Medical School, 38039 Kayseri, Turkey
                4Department of Radiology, Erciyes University Medical School, 38039 Kayseri, Turkey
                5Department of Internal Diseases, Erciyes University Medical School, 38039 Kayseri, Turkey
                Author notes

                Academic Editor: Wayne V. Moore

                Author information
                http://orcid.org/0000-0003-2519-5978
                Article
                10.1155/2014/283458
                4269281
                d5626b7e-0dfe-44a8-90c0-551a6d32d257
                Copyright © 2014 Halit Diri et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 August 2014
                : 18 November 2014
                Categories
                Case Report

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