(1.10) Cushing's Syndrome Presenting As Uncontrolled Hyperglycemia In Pregnancy

Due to the effects of excess glucocorticoid, pregnancy is an unusual occurrence in Cushing’s syndrome. The first case of Cushing’s syndrome in a pregnant lady was described in 1953 by Hunt and McConahey and post that fewer than 200 publications are available in world literature. It is difficult to diagnose Cushing’s syndrome (CS) in a pregnant lady as similar characteristics may be found in normal pregnancy, preeclampsia, and gestational diabetes mellitus. Uncontrolled hyperglycemia and hypertension may be the reason to seek medical attention for some patients which can lead to the diagnosis of this rare condition.

Case(s) Description :

Here we report a 29-year-old lady at 17th week of gestation being admitted to the cardiology unit of a multi-speciality hospital for shortness of breath and uncontrolled hyperglycemia. She also had hypertension, edema and hypokalemia. She was admitted in the cardiology intensive care unit and then referred to the endocrinologist for glycemic control. She was diagnosed with CS based on her symptoms, signs and biochemical parameters. The patient’s husband and relatives did not want to undergo operative management of CS during pregnancy. The pregnancy was terminated at 19 weeks of gestation after an informed consent. Later on she underwent laparoscopic adrenalectomy for a left adrenal adenoma. The patient recovered completely and was doing fine in the follow up outdoor visits.

Discussion :

CS in pregnancy is seldom encountered and is associated with diagnostic dilemma from both clinical and laboratory perspective. It often leads to significant maternal and fetal complications. CS during pregnancy is more frequently a result of adrenal adenomas. The most appropriate treatment is adrenalectomy in the early second trimester.  Medical therapy is usually not the first line of management and may be considered in patients not fit for surgery. The highlight of this case was that an atypical condition was diagnosed following a routine referral to the endocrinologist for in hospital glycemic management. Due to rarity of the disease there is dearth of consensus on the appropriate management of such patients. A multidisciplinary management approach is needed to prevent untoward complications.