Chief Cushie ~MaryO~ Posted August 5, 2010 Chief Cushie Report Share Posted August 5, 2010 Mundra, Vishal MD; Solorzano, Carmen C. MD, FACS; DeSantis, Pascual MD This is a case of a 32-year-old woman who presented to the clinic at 11 weeks of gestation after she was found to have an adrenal mass during the work up of hypertension. An MRI prior to pregnancy revealed a right-sided 4.8-cm adrenal mass. On examination, the patient was overweight, with no other features of Cushing syndrome like striae, buffalo hump, etc. At 15 weeks, her 24-hour urine cortisol was 1095 mcg/24 hours (4.0?50.0 mcg/24 h). Her repeat 24-hour urine cortisol at 21 and 25 weeks of gestation were 1655 and 3039 mcg, respectively. Her morning adrenocorticotropic hormone level was undetectable. During the second trimester, she developed acne, striae, truncal obesity, and a ?buffalo hump.? After consulting with her surgeon, she opted for adrenalectomy after pregnancy. At 22 weeks, she was started on metyrapone 250 mg daily but the urinary free cortisol remain elevated. She had an emergent C-section at 34 weeks due to fetal heart decelerations. Metyrapone was discontinued after delivery. Surprisingly, the 24-hour urine Cortisol spontaneously dropped to 7.2 mcg prior to surgery. A repeat CT prior to adrenalectomy revealed an increase in the size of the adrenal mass. The patient had an uneventful laparoscopic right adrenalectomy 2 months after delivery. The pathology was consistent with a cortical adenoma. The largest diameter of the tumor was 9 cm. The patient and the baby remained asymptomatic after the surgery. From http://journals.lww.com/theendocrinologist/Abstract/2010/07000/Cushing_Syndrome__A_Rare_Occurrence_in_Pregnancy.8.aspx Link to comment Share on other sites More sharing options...
Member of the 1000 Post Club MelanieUK Posted August 6, 2010 Member of the 1000 Post Club Report Share Posted August 6, 2010 The fact that her cortisol "spontaneously dropped to 7.2 mcg prior to surgery" begs the question does/did she have aberrent receptors reacting to LH/HCG like I did? I bet they didn't even test the gland after surgery to see if was reacting to anything specific. The dose of 250mg of Metyrapone was probably too small to alter her cortisol levels anyway, that's only one pill a day! Good find though Mary. Link to comment Share on other sites More sharing options...
peaches Posted August 6, 2010 Report Share Posted August 6, 2010 Interesting, thanks for the article Link to comment Share on other sites More sharing options...
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