Cushing’s Syndrome and Pregnancy

Diagnosis of Cushing's syndrome in pregnancy is difficult because of the physiologic hypercorticism that is characteristic of normal pregnancy, as well as significant limitations in hormone analysis and visualization techniques. At the same time, endogenous hypercorticism during pregnancy is associated with both increased risk for the fetus (prematurity, delayed intrauterine development, spontaneous abortions) and a high level of complications for the mother's organism, such as arterial hypertension, gestational diabetes, preeclampsia, osteoporosis, psychiatric disorders, etc. The article considers a clinical case of Cushing's syndrome during pregnancy in a young woman. The course of the disease was accompanied by metabolic and hemodynamic disorders, which led to the development of severe preeclampsia in the third trimester and caused emergency delivery by cesarean section in the patient. Timely diagnosis of the disease was hindered by the condition of pregnancy, which limited the range of hormonal studies and visualization methods, as well as by the special anti-epidemic regime at the time in health care facilities due to a new coronavirus infection. Cases of Cushing's syndrome detection during pregnancy are rare. The article summarizes current recommendations for the diagnosis of endogenous hypercorticism during pregnancy, suggesting such tests as late-night salivary cortisol levels or midnight serum cortisol levels, as well as cortisol in daily urine (3-fold or higher than the upper limit of normal) as possible diagnostic tests. Late-night suppressive test with dexamethasone is not recommended during pregnancy.