ACTH-INDEPENDENT CUSHINGS-SYNDROME IN PREGNANCY WITH SPONTANEOUS RESOLUTION AFTER DELIVERY - CONTROL OF THE HYPERCORTISOLISM WITH METYRAPONE

A 25-year-old primigravid woman presented with Cushing's syndrome at 2 3 weeks gestation; serum cortisol was 1090 nmol/l at 0900 h, 1230 nmol /l at 2200 h; basal urinary free cortisol excretion was 3680 nmol/24 h , and 8830 nmol/24 h after dexamethasone 8 mg daily for 48 hours; plas ma ACTH was < 1.1 pmol/l. CT scan of the adrenal glands showed bilater al adrenal hyperplasia. The hypercortisolism was controlled with metyr apone until elective delivery of the fetus by Caesarian section at 34 weeks gestation because of a decline in growth. No adverse fetal effec ts of metyrapone treatment were apparent, maternal outcome was uncompl icated and wound healing was unimpaired. Maternal adrenocortical funct ion had returned to normal within 4 weeks of the cessation of pregnanc y and biochemical remission has been maintained up to 9 months post-pa rtum. Metyrapone therapy is effective in controlling the hypercortisol ism in certain cases of Cushing's syndrome complicating pregnancy.