CUSHINGS-DISEASE AND PREGNANCY - REPORT OF 6 CASES

We describe six pregnancies in five patients with Cushing's disease - four had undergone transsphenoidal surgery, with improvement but no cu re of their hypercortisolism; the other woman became pregnant during i nitial work up. At conception, none of the patients were receiving spe cific treatment for hypercortisolism. Mean free urinary cortisol (FUG) prior to pregnancy was 430 nmol/24 h (normal range: 51-280). In two p atients, FUC throughout pregnancy increased significantly, but no clin ical progression was observed. FUC measured in 20 healthy pregnant wom en was found to rise above the normal non-pregnant range (< 280 nmol/2 4 h) in the second (mean +/- 2 S.D. = 463 +/- 256 nmol/24 h; P < 0.01) and third trimester (424 +/- 210 nmol/24 h; P < 0.05). However, in th e Cushing patients values were higher. Two pregnancies ended in sponta neous abortions, one resulted in an ectopic pregnancy, and the remaini ng three were followed to term of which one developed third trimester gestational diabetes, and her baby developed neonatal sepsis which res olved uneventfully. We conclude that despite high abortion and ectopic pregnancy rates, a remarkably uneventful and uncomplicated outcome wi th no clinical progression of cushingoid symptoms, was observed in two of the three pregnancies followed to term, despite significant increa ses in FUC.