Description

pregnancy with Cushing's syndrome due to an adrenal cortical adenoma, in which the hypercortisolemia disappeared during the third trimester of pregnancy, but recurred following the delivery of a normal male infant at 38 weeks by Cesarean section. The case is also unique because plasma ACTH levels were elevated during gestation and postpartum. Also, urinary estriol excretion was very low during the third trimester of pregnancy. The relationship of Cushing's syndrome and pregnancy are reviewed. This study points up some of the limitations of the routinely used dynamic tests of pituitary-adrenal function in Cushing's syndrome, and emphasizes the importance of various radiologic procedures in evaluation of patients with Cushing's syndrome.

A 74-year old female taking medroxyprogesterone acetate (MPA) presented with Cushing's syndrome together with low serum cortisol and plasma ACTH and an impaired response to synthetic ACTH (Snatcher, CIBA). When the medroxyprogesterone therapy was ceased the cushingoid features resolved and serum cortisol, ACTH and ACTH responsiveness all returned to normal. The MPA was acting as an exogenous glucocorticoid causing Cushing's syndrome. The potential role of Para neoplastic Cushing's syndrome (CS) was assessed on the clinical course of patients with small cell lung cancer. A retrospective comparison was done of complication and survival rates according to the presence or absence of CS in patients with small cell lung cancer who died within 90 days of initial administration of chemotherapy. The setting was a comprehensive cancer center. Eleven patients with clinical and/or biochemical features of CS were identified from among 90 patients who presented between 1979 and 1989 with previously untreated small cell lung cancer. The group with CS and the control patients were compared in terms of clinic pathologic prognostic factors, treatment, and outcome. Patients with CS were comparable to the control patients in all prognostic factors, including tumor stage and cancer treatment. Eight-two percent of patients with CS (nine of 11) died within 14 days of initiation of chemotherapy compared with 25% of the control patients (19 of 77). The median survival from initiation of chemotherapy was 12 days for the 11 patients with CS and 27 days for the 77 control patients. In 45% of the patients with CS (five of 11), death was attributed to opportunistic fungal or protozoa infection compared with 8% of control patients (six of 77). Para neoplastic CS is a previously unrecognized adverse prognostic factor for patients with small cell lung cancer. Those with both small cell lung cancer and CS have severe opportunistic infections soon after the initiation of chemotherapy, leading to clinical deterioration and death before antineoplastic benefit from chemotherapy can be achieved. Biochemical control of CS for at least 1 to 2 weeks before initiation of chemotherapy may ameliorate the poor prognosis.

Kindly submit your manuscript through https://www.imedpub.com/submissions/reproductive-endocrinology-infertility.html

With Regards
Martin

Journal Coordinator
Journal of Reproductive Endocrinology & Infertility