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Management of the Patient with Cushing’s Syndrome During Pregnancy

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Pituitary Disorders throughout the Life Cycle

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Abstract

Cushing’s syndrome (CS) in pregnancy is extremely rare, due to the negative effects of hypercortisolism on the gonadal axis and fertility. When it occurs, it is a severe condition, associated with potentially lethal complications for both the mother and the fetus. To diagnose new-onset or recurrent CS in a pregnant woman is challenging due to the physiological and transient hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis occurring during normal gestation, which may mask an underlying, pathological cortisol excess. Pregnant women with CS should be managed by a multidisciplinary team of experts in high-risk pregnancies, including obstetricians, pituitary specialists, neonatologists, and specialized endocrine surgeons. Whereas treatment of mild cases of CS, especially if diagnosed in later pregnancy, may only be directed to control comorbidities, CS should be otherwise treated due to the elevated morbidity and mortality in both the mother and the fetus, and surgery is usually the first-line treatment. Metyrapone has been safely used in some patients, but the use of medical therapy should be limited to those cases where surgery is contraindicated.

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Authors and Affiliations

  1. IIB-Sant Pau and Department of Endocrinology/Medicine, Hospital Sant Pau, Universitat Autónoma de Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unit 747), ISCIII, Barcelona, Spain

    Elena Valassi, Luciana Martel & Susan M. Webb

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  1. Elena Valassi
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  2. Luciana Martel
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  3. Susan M. Webb
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Correspondence to Elena Valassi .

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Editors and Affiliations

  1. Mayo Clinic, Jacksonville, FL, USA

    Susan L. Samson

  2. Emory University School of Medicine, Atlanta, GA, USA

    Adriana G. Ioachimescu

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Valassi, E., Martel, L., Webb, S.M. (2022). Management of the Patient with Cushing’s Syndrome During Pregnancy. In: Samson, S.L., Ioachimescu, A.G. (eds) Pituitary Disorders throughout the Life Cycle. Springer, Cham. https://doi.org/10.1007/978-3-030-99918-6_16

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  • DOI: https://doi.org/10.1007/978-3-030-99918-6_16

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-99917-9

  • Online ISBN: 978-3-030-99918-6

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