Síndrome de Cushing ATCH-dependiente durante el embarazo tratado con metirapona / ACTH-dependent Cushing’s syndrome during pregnancy treated with metyrapone

ABSTRACT

Cushing’s syndrome (CS) rarely occurs during pregnancy due to the influence of the hypercortisolism on the reproductive axis, with only a few cases described. We present a case of a 32 years-old woman diagnosed with ACTH-dependent CS and no clear pituitary lesion on the MRI. She was on ketoconazole when she discovered she was 8-weeks pregnant. Ketoconazole was stopped and a conservative management was decided. At 26 weeks of gestation, the patient developed gestational diabetes and treatment with metyrapone was started. Metyrapone was well tolerated and the pregnancy proceeded without further complications. She gave birth to a male infant, via cesarean section, at 36 weeks, with no apparent teratogenic effects of metyrapone. Many authors consider surgery as the first-choice treatment in pregnant women with CS but there is no consensus on the best management in such patients. Pharmacological treatment with metyrapone may be a safe and effective alternative. (AU)