{"title":"A case of Cushing's syndrome in a pregnant woman associated with hypertension, hypokalemia, and gestational diabetes mellitus.","authors":"Hajime Sugawara, Norio Wada, Shuhei Baba, Arina Miyoshi, Shinji Obara, Yuto Yamazaki, Hironobu Sasano","doi":"10.1007/s13340-024-00745-2","DOIUrl":null,"url":null,"abstract":"<p><p>We report the case of a 33-year-old woman who was referred to the department of endocrinology and diagnosed with gestational diabetes mellitus (GDM). She had been hypertensive from 20 weeks of pregnancy. A 75 g oral glucose tolerance test for screening of GDM at 26 weeks of pregnancy revealed positive results at two points: 183 mg/dL at 60 min, and 193 mg/dL at 90 min. At the first visit to the Department of Endocrinology, Cushing's features were clinically unclear. She started self-monitoring blood glucose levels, and hypokalemia was detected. At 28 weeks of pregnancy, she was admitted to our hospital because of uncontrolled blood pressure. The patient started multiple injections of rapid insulin for postprandial hyperglycemia. Laboratory testing revealed suppressed plasma ACTH (< 1.5 pg/mL) and elevated serum cortisol levels (34.1 μg/dL) in the early morning. Because of uncontrollable pregnancy related complications, the patient delivered a baby by Caesarean section at 29 weeks of pregnancy. After delivery, she was diagnosed with ACTH-independent Cushing's syndrome by endocrinological tests. Computed tomography scan demonstrated a right adrenal tumor measuring 24 mm at greatest dimension. Twenty-three days after delivery, laparoscopic right adrenalectomy was performed. The diagnosis of cortisol-producing adrenocortical adenoma was pathologically confirmed. After surgery, the patient was given glucocorticoids as a replacement, and her blood pressure, blood glucose, and serum potassium levels were normalized. Although rare, GDM may be caused by Cushing's syndrome. Pregnant women with combinations of GDM, hypertension, and hypokalemia should be clinically suspected as harboring Cushing's syndrome even in the absence of specific clinical features.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512942/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetology International","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s13340-024-00745-2","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
Abstract
We report the case of a 33-year-old woman who was referred to the department of endocrinology and diagnosed with gestational diabetes mellitus (GDM). She had been hypertensive from 20 weeks of pregnancy. A 75 g oral glucose tolerance test for screening of GDM at 26 weeks of pregnancy revealed positive results at two points: 183 mg/dL at 60 min, and 193 mg/dL at 90 min. At the first visit to the Department of Endocrinology, Cushing's features were clinically unclear. She started self-monitoring blood glucose levels, and hypokalemia was detected. At 28 weeks of pregnancy, she was admitted to our hospital because of uncontrolled blood pressure. The patient started multiple injections of rapid insulin for postprandial hyperglycemia. Laboratory testing revealed suppressed plasma ACTH (< 1.5 pg/mL) and elevated serum cortisol levels (34.1 μg/dL) in the early morning. Because of uncontrollable pregnancy related complications, the patient delivered a baby by Caesarean section at 29 weeks of pregnancy. After delivery, she was diagnosed with ACTH-independent Cushing's syndrome by endocrinological tests. Computed tomography scan demonstrated a right adrenal tumor measuring 24 mm at greatest dimension. Twenty-three days after delivery, laparoscopic right adrenalectomy was performed. The diagnosis of cortisol-producing adrenocortical adenoma was pathologically confirmed. After surgery, the patient was given glucocorticoids as a replacement, and her blood pressure, blood glucose, and serum potassium levels were normalized. Although rare, GDM may be caused by Cushing's syndrome. Pregnant women with combinations of GDM, hypertension, and hypokalemia should be clinically suspected as harboring Cushing's syndrome even in the absence of specific clinical features.
期刊介绍:
Diabetology International, the official journal of the Japan Diabetes Society, publishes original research articles about experimental research and clinical studies in diabetes and related areas. The journal also presents editorials, reviews, commentaries, reports of expert committees, and case reports on any aspect of diabetes. Diabetology International welcomes submissions from researchers, clinicians, and health professionals throughout the world who are interested in research, treatment, and care of patients with diabetes. All manuscripts are peer-reviewed to assure that high-quality information in the field of diabetes is made available to readers. Manuscripts are reviewed with due respect for the author''s confidentiality. At the same time, reviewers also have rights to confidentiality, which are respected by the editors. The journal follows a single-blind review procedure, where the reviewers are aware of the names and affiliations of the authors, but the reviewer reports provided to authors are anonymous. Single-blind peer review is the traditional model of peer review that many reviewers are comfortable with, and it facilitates a dispassionate critique of a manuscript.