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Cushing's Disease & Pregnancy

Cushing's disease is a hormone disorder in which a tumor causes the body to produce excessive amounts of cortisol, a stress hormone. While multiple areas in the body could produce an excessive output, Cushing's disease is confined to cases caused by a tumor of the pituitary gland in the brain. True Cushing's disease is rare in pregnancy because it is normally accompanied by other hormonal changes that make conception unlikely. When it does occur, it can result in serious complications for both mother and fetus.

  1. Normal Cortisol Function

    • Cortisol is normally secreted by the adrenal glands. Normal cortisol production is essential for a myriad of bodily functions including regulating blood pressure and glucose levels. Low cortisol levels can result in weakness, anorexia, nausea and vomiting, diarrhea and constipation, even shock and death. Cortisol output of the adrenal gland is controlled by the secretion of other hormones from the hypothalamus and the pituitary in the brain. Tumors in any of these locations can cause Cushing's disease.

    Cushing's Syndrome

    • Cushing's syndrome refers to any condition where an excess of cortisol-like substances causes a cluster of symptoms. Like Cushing's disease, it is rarely found in pregnant women. Symptoms usually include centripetal obesity (a redistribution of fat away from the limbs and to the abdomen and back), fatigue, weakness and high blood pressure. The most common cause of Cushing's syndrome is administration of corticosteroids (cortisol-like medications), which are used to treat a wide variety of disorders.

    Conception and Early Pregnancy

    • Tumors that increase levels of cortisol, particularly those of the pituitary and hypothalamus, usually suppress ovulation, making pregnancy impossible. It is possible, however, for tumors to develop over the course of a pregnancy. This circumstance is thought to account for those cases of Cushing's disease that have been observed during pregnancy. Diagnosing Cushing's disease during pregnancy can be challenging, since cortisol levels in normal women increase significantly in response to the ordinary hormonal changes that occur when a woman is pregnant. Cushing's syndrome sometimes occurs in pregnancy when a woman is given corticosteroids to treat another disorder.

    Complications of Cushing's Disease in Pregnancy

    • High levels of cortisol alone during pregnancy do not appear to be terribly damaging to the fetus. Most complications seen from Cushing's disease in pregnancy result from effects on the health of the mother, which can in turn affect the health of the developing fetus. The most common maternal complication is high blood pressure, which can lead to a very serious complication of pregnancy called preeclampsia. Cushing's disease can also predispose a woman toward diabetes during pregnancy. These conditions can lead to fetal growth restriction, pre-term delivery and even fetal death.

    Treatment in Pregnancy

    • The preferred treatment of Cushing's disease is surgical removal of the tumor. Medications for treating the disease are sometimes effective, but most cannot safely be used while pregnant. Maternal surgery and anesthesia can be complicated during pregnancy, depending upon the overall health of the mother and the fetus. Therefore, mild cases of Cushing's disease are usually not treated until after delivery. Serious cases require a careful balancing of risks and benefits before proceeding with surgery.

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