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Persistent vs Recurrent Cushing's Disease Diagnosed Four Weeks Postpartum

BACKGROUND: Cushing's disease (CD) recurrence in pregnancy is thought to be associated with estradiol fluctuations during gestation. CD recurrence in the immediate postpartum period in a patient with a documented dormant disease during pregnancy has never been reported. Case Report. A 30-year-o...

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Autores principales: Shah, Leena, Nosova, Emily V., Bederson, Joshua B., Cheesman, Khadeen Christi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9392589/
https://www.ncbi.nlm.nih.gov/pubmed/35996523
http://dx.doi.org/10.1155/2022/9236711
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author Shah, Leena
Nosova, Emily V.
Bederson, Joshua B.
Cheesman, Khadeen Christi
author_facet Shah, Leena
Nosova, Emily V.
Bederson, Joshua B.
Cheesman, Khadeen Christi
author_sort Shah, Leena
collection PubMed
description BACKGROUND: Cushing's disease (CD) recurrence in pregnancy is thought to be associated with estradiol fluctuations during gestation. CD recurrence in the immediate postpartum period in a patient with a documented dormant disease during pregnancy has never been reported. Case Report. A 30-year-old woman with CD had improvement of her symptoms after transsphenoidal resection (TSA) of her pituitary lesion. She conceived unexpectedly 3 months postsurgery and had no symptoms or biochemical evidence of recurrence during pregnancy. After delivering a healthy boy, she developed CD 4 weeks postpartum and underwent a repeat TSA. Despite repeat TSA, she continued to have elevated cortisol levels that were not well controlled with medical management. She eventually had a bilateral adrenalectomy. Discussion. CD recurrence may be higher in the peripartum period, but the link between pregnancy and CD recurrence and/or persistence is not well studied. Potential mechanisms of CD recurrence in the postpartum period are discussed below. CONCLUSION: We describe the first report of recurrent CD that was quiescent during pregnancy and diagnosed in the immediate postpartum period. Understanding the risk and mechanisms of CD recurrence in pregnancy allows us to counsel these otherwise healthy, reproductive-age women in the context of additional family planning.
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spelling pubmed-93925892022-08-21 Persistent vs Recurrent Cushing's Disease Diagnosed Four Weeks Postpartum Shah, Leena Nosova, Emily V. Bederson, Joshua B. Cheesman, Khadeen Christi Case Rep Endocrinol Case Report BACKGROUND: Cushing's disease (CD) recurrence in pregnancy is thought to be associated with estradiol fluctuations during gestation. CD recurrence in the immediate postpartum period in a patient with a documented dormant disease during pregnancy has never been reported. Case Report. A 30-year-old woman with CD had improvement of her symptoms after transsphenoidal resection (TSA) of her pituitary lesion. She conceived unexpectedly 3 months postsurgery and had no symptoms or biochemical evidence of recurrence during pregnancy. After delivering a healthy boy, she developed CD 4 weeks postpartum and underwent a repeat TSA. Despite repeat TSA, she continued to have elevated cortisol levels that were not well controlled with medical management. She eventually had a bilateral adrenalectomy. Discussion. CD recurrence may be higher in the peripartum period, but the link between pregnancy and CD recurrence and/or persistence is not well studied. Potential mechanisms of CD recurrence in the postpartum period are discussed below. CONCLUSION: We describe the first report of recurrent CD that was quiescent during pregnancy and diagnosed in the immediate postpartum period. Understanding the risk and mechanisms of CD recurrence in pregnancy allows us to counsel these otherwise healthy, reproductive-age women in the context of additional family planning. Hindawi 2022-08-13 /pmc/articles/PMC9392589/ /pubmed/35996523 http://dx.doi.org/10.1155/2022/9236711 Text en Copyright © 2022 Leena Shah et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Shah, Leena
Nosova, Emily V.
Bederson, Joshua B.
Cheesman, Khadeen Christi
Persistent vs Recurrent Cushing's Disease Diagnosed Four Weeks Postpartum
title Persistent vs Recurrent Cushing's Disease Diagnosed Four Weeks Postpartum
title_full Persistent vs Recurrent Cushing's Disease Diagnosed Four Weeks Postpartum
title_fullStr Persistent vs Recurrent Cushing's Disease Diagnosed Four Weeks Postpartum
title_full_unstemmed Persistent vs Recurrent Cushing's Disease Diagnosed Four Weeks Postpartum
title_short Persistent vs Recurrent Cushing's Disease Diagnosed Four Weeks Postpartum
title_sort persistent vs recurrent cushing's disease diagnosed four weeks postpartum
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9392589/
https://www.ncbi.nlm.nih.gov/pubmed/35996523
http://dx.doi.org/10.1155/2022/9236711
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