Pregnancy-associated Cushing’s disease? An exploratory retrospective study
In most clinical series of Cushing’s disease (CD), over 80% of patients are women, many of whom are of reproductive age. The year following pregnancy may be a common time to develop CD. We sought to establish the incidence of CD onset associated with pregnancy.
A retrospective review was conducted for patients with biochemically-proven CD. Demographics, clinical history, biochemistry, imaging, pathology, and outcomes were reviewed. Pregnancy-associated CD was defined as symptom onset within 1 year of childbirth.
Over 10 years, 77 patients including 64 women (84%), with CD underwent endonasal surgery. Of the 64 women, 64% were of reproductive age (15–45 years) at the time of diagnosis, and 11 (27%) met criteria for pregnancy-associated CD. Of these 11 women, median number of pregnancies prior to onset of CD was 2 (range 1–4) compared to zero (range 0–7) for 30 other women with CD onset during reproductive age (p = 0.0024). With an average follow-up of 47 ± 34 months, sustained surgical remission rates for woman with pregnancy-associated CD, other women of reproductive age, and women not of reproductive age were 91%, 80% and 83%, respectively. The average lag-time from symptom onset to diagnosis for women with pregnancy-associated CD was 4 ± 2 years.
In this exploratory study, over one quarter of women of reproductive age with CD appeared to have symptomatic disease onset within 1 year of childbirth. This relatively high rate of pregnancy-associated CD suggests a possible causal relationship related to the stress of pregnancy and pituitary corticotroph hyperactivity in the peripartum period. This possible association suggests a heightened degree of clinical suspicion and biochemical testing for CD may be warranted after childbirth. Further study of this possible link between pregnancy and CD is warranted.
KeywordsPregnancy Peripartum Cushing’s disease Hypercortisolemia Pituitary adenoma Corticotrophs
Corticotroph releasing hormone
Inferior petrosal sinus sampling
Magnetic resonance imaging
We would like to thank the John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, CA for their ongoing support of our research.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest to disclose.
- 1.Etxabe J, Vazquez JA (1994) Morbidity and mortality in Cushing’s disease: an epidemiological approach. Clin Endocrinol (Oxf) 40:479–484. https://doi.org/10.1111/j.1365-2265.1994.tb02486.x CrossRefGoogle Scholar
- 11.Esposito F, Dusick JR, Fatemi N, Kelly DF (2007) Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Oper Neurosurg 60:295–304. https://doi.org/10.1227/01.NEU.0000255354.64077.66 CrossRefGoogle Scholar
- 20.World (2018) Fertility rate, total (births per woman). In: World Bank. https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?