Cushing’s syndrome might lead to congestive heart failure — when the heart pumps blood inefficiently, causing stress in internal organs and fluid retention — in pregnant women, a case report suggests.
If doctors suspect Cushing’s syndrome during pregnancy, they should make timely decisions to avoid complications for the mother and baby.
The case report, “Successful Management of Acute Congestive Heart Failure by Emergent Caesarean Section Followed byAdrenalectomy in a Pregnant Woman with Cushing’s Syndrome-induced Cardiomyopathy,” was published in the journal Internal Medicine.
Cushing’s syndrome among pregnant women is difficult to diagnose because the symptoms and lab exams characteristic of Cushing’s are similar to those of pregnancy, and doctors avoid performing invasive procedures in pregnant women for the sake of the fetus. However, it is important to diagnose and treat this condition to prevent complications in the mother and baby.
Researchers in Japan reported the case of a 35-year-old woman who developed congestive heart failure as a consequence of Cushing’s syndrome during her third trimester of pregnancy.
The patient went for the first time to the hospital after 16 weeks of gestation because she had high blood pressure and had gained 18 kilograms (about 40 pounds).
Her lab exams and kidney and thyroid function were almost normal, and her blood pressure at home remained borderline normal and constant. So, the doctors decided to observe how she progressed without prescribing any medication.
The patient was admitted to the hospital in her 35th week of pregnancy because she had shortness of breath and elevated blood pressure, heart rate, and respiratory rate. Her exams showed respiratory failure and excess of prolactin in the blood.
The imaging exams showed the lungs were congested and the left ventricle was not functioning well, which indicated heart failure. The woman received oxygen through a ventilator and medication to improve heart function, which lessened the symptoms partially.
However, the patient needed more intensive care, and there was a risk that the fetus was not receiving enough oxygen. Doctors decided to perform an emergency cesarean section. The baby was healthy at birth and did not develop any health complications in the following year.
The patient was treated in the intensive care unit with ventilation and medication for heart failure. A CT scan showed a tumor in her left adrenal gland (the glands located above the kidneys that secrete cortisol).
Lab exams showed high cortisol levels and undetectable adrenocorticotropic hormone (ACTH), which led to a diagnosis of ACTH-independent Cushing’s syndrome. The doctors suspected that the excessive amounts of cortisol produced by the tumor caused heart failure.
The woman underwent surgery to remove the tumor and was discharged on heart medications and glucocorticoids. The analysis of the tumor confirmed it produced cortisol.
Eight months after the surgery, the levels of cortisol and those of hormones that control cortisol production were normal, so the patient stopped taking glucocorticoids.
A year after the surgery, the woman had recovered normal heart function, and the shortness of breath had disappeared. The exams showed no further damage to the heart or other internal organs. The fact that heart failure resolved after removing the adrenal tumor supports the premise it was a consequence of Cushing’s syndrome.