Cushing Syndrome and Pregnancy: Report of Two Cases

Pregnancy rarely occurs in Cushing syndrome because it is a cause of maternal and fetal complications related to arterial hypertension, cardiovascular disease, and diabetes mellitus leading to increased perinatal morbidity and mortality. The purpose of this work is to report our experience with two cases of pregnancy associated with Cushing syndrome diagnosed by urinary cortisol and dynamic tests plus pituitary and adrenal magnetic resonance imaging (MRI). Case no. 1 is a 27-year-old woman with abnormal pituitary and adrenal images, was followed during her pregnancy with controlled glucose and blood pressure levels, and went to premature labor at the 34th week of gestation. The baby was severely affected by anoxia and was underweight, surviving after intensive care. Case no. 2 is a 28-year-old woman with a right adrenal mass and undetectable ACTH levels who had severe depression and diabetes mellitus requiring increasing insulin doses. She had a right adrenalectomy at 27 weeks of pregnancy. Afterward, blood pressure was normal and glucose control improved. At 38 weeks of gestation, a cesarean section was performed with no maternal-fetal complications. In cases in which blood glucose can be well controlled and blood pressure can be effectively managed, patients should be followed to the end of pregnancy. In those cases with difficult blood glucose and blood pressure control, surgical treatment is indicated during the second trimester as a result of the high matemal-fetal complication rate.