Report Describes Two Cases of Cushing’s Syndrome Diagnosis After Pregnancy

Two cases of Cushing’s syndrome that were diagnosed following pregnancy are described in a new report, which highlights the difficulty of recognizing the rare disorder in pregnant women.

The report, “Cushing’s syndrome in pregnancy, diagnosed after delivery,” was published in Yeungnam University Journal of Medicine in Korea.

Cushing’s syndrome (CS) is characterized by hypercortisolism (abnormally high levels of the stress hormone cortisol).

Because hypercortisolism can interfere with normal ovarian function, it is very uncommon for people with Cushing’s syndrome to become pregnant; only about 220 cases of Cushing’s syndrome in pregnancy have been reported. Even if pregnancy occurs, hypercortisolism is associated with an increased risk of complications, both to the mother and the fetus.

The new report describes two people with Cushing’s syndrome that was diagnosed following pregnancies.

The first patient, a 37-year-old, became pregnant in 2013. She had a history of hypertension (high blood pressure) and elevated blood fat levels, and was receiving regular treatment for these conditions. Due to pulmonary arterial hypertension, the patient underwent a cesarean section after 35 weeks of pregnancy.

In the five months after the baby was delivered, the patient experienced persistent flank pain and gained 14 kg (about 30 pounds), prompting a hospital visit. On examination, the patient had Cushing’s-like features, including stretch marks and abdominal obesity, and laboratory tests indicated hypercortisolism.

Further testing identified a tumor in one of the patient’s adrenal glands;  adrenal tumors are a known cause of Cushing’s syndrome. The tumor was surgically removed, resulting in a resolution of symptoms.

The second case, a 35-year-old, was diagnosed with gestational diabetes during her 25th week of pregnancy before delivering a baby via cesarean section at 37 weeks. Eight months after delivery, the patient went to the hospital due to weight gain, bruising, and because menstruation had not yet resumed, even though the patient had stopped breastfeeding.

Physical examination revealed Cushing’s-like features including stretch marks and bruising, and laboratory tests confirmed hypercortisolism. Further testing identified a tumor on the pituitary gland; pituitary tumors are the cause of Cushing’s disease, which is a form of Cushing’s syndrome. As with the first patient, the tumor was surgically removed, leading to a resolution of symptoms.

Although both patients were not diagnosed with Cushing’s syndrome until after pregnancy, a diagnosis of Cushing’s syndrome within 12 months of pregnancy usually means that Cushing’s syndrome was active during pregnancy.

In these cases, it is probable that symptoms of Cushing’s syndrome were missed during pregnancy, because the symptoms (e.g., weight gain) were masked by normal physiological changes that occur during pregnancy.

“In the present patients, the symptoms reported are common features of pregnancy, meaning that it would have been difficult to diagnose CS earlier,” the researchers wrote.

As such, these cases highlight the difficulty of diagnosing Cushing’s syndrome in pregnant women. They also highlight the complications that hypercortisolism can cause during pregnancy.

“In both the patients reported here, maternal complications occurred during pregnancy and one neonate [newborn] was born preterm and both were a low birth weight,” the researchers wrote.

Because of the risk of such complications, early diagnosis of Cushing’s syndrome in pregnancy is important. As such, the authors suggest that healthcare providers should consider whether pregnant patients might have Cushing’s syndrome if they have suspicious symptoms, most notably certain kinds of fractures.