Pregnancy-associated Cushing's disease? An exploratory retrospective study.

Authors

Sheri K Palejwala, Pacific Neuroscience Institute, John Wayne Cancer Institute at Providence's Saint John's Health Center, 2125 Arizona Ave., Santa Monica, CA, 90404, USAFollow
Andrew R Conger, Pacific Neuroscience Institute, John Wayne Cancer Institute at Providence's Saint John's Health Center, 2125 Arizona Ave., Santa Monica, CA, 90404, USAFollow
Amy Eisenberg, Pacific Neuroscience Institute, Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Providence Saint John's Health Center, 2200 Santa Monica Blvd., Santa Monica, CA, 90404, USA.Follow
Pejman Cohan, Pacific Neuroscience Institute, John Wayne Cancer Institute at Providence's Saint John's Health Center, 2125 Arizona Ave., Santa Monica, CA, 90404, USA
Chester Griffiths, Providence St. John's Health Center, Los Angeles, CA, USAFollow
Garni Barkhoudarian, John Wayne Cancer Institute Santa Monica, California.Follow
Daniel F Kelly, Pacific Neuroscience Institute, John Wayne Cancer Institute at Providence's Saint John's Health Center, 2125 Arizona Ave., Santa Monica, CA, 90404, USAFollow

Document Type

Article

Publication Date

9-14-2018

Publication Title

Pituitary

Keywords

Corticotrophs; Cushing’s disease; Hypercortisolemia; Peripartum; Pituitary adenoma; Pregnancy

Abstract

PURPOSE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Clinical Institute

Neurosciences (Brain & Spine)

Clinical Institute

Women & Children

Department

Neurosciences

Department

Obstetrics & Gynecology

Recommended Citation

Palejwala, Sheri K; Conger, Andrew R; Eisenberg, Amy; Cohan, Pejman; Griffiths, Chester; Barkhoudarian, Garni; and Kelly, Daniel F, "Pregnancy-associated Cushing's disease? An exploratory retrospective study." (2018). Articles, Abstracts, and Reports. 711.
https://digitalcommons.providence.org/publications/711