Diagnosis of Cushing during pregnancy is easier with the desmopressin test

The desmopressin stimulation test may be useful in diagnosing Cushing’s disease during pregnancy, a time when its identification can be particularly difficult due to the hormonal changes these women undergo, according to a new case report.

The report, “Desmopressin stimulation test in a pregnant patient with Cushing’s disease, ”Was published in the journal AACE Clinical Case Reports.

Cushing’s disease is caused by a tumor in the pituitary gland, located in the brain. The tumor causes the gland to produce and release high levels of a signaling molecule called adrenocorticotropic hormone (ACTH), which in turn causes the adrenal glands, located just above the kidneys, to produce excessive amounts of cortisol. , the stress hormone. High levels of cortisol are ultimately the cause of Cushing’s symptoms.

Cushing’s diagnosis usually involves looking for evidence of elevated levels of ACTH. During pregnancy, however, ACTH levels naturally increase, making it difficult to diagnose the condition in a pregnant woman.

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Here, scientists from Thailand described the case of a 27-year-old woman who was diagnosed with Cushing’s disease while pregnant using the desmopressin stimulation test.

When she was nine weeks pregnant, the woman had a typical Cushing appearance (eg, purple stretch marks, bruises) and muscle weakness that had lasted for two months.

She had a history of high blood pressure and abnormal blood sugar levels, and in the two years before her pregnancy, she had gained 20 kg (approximately 44 lbs).

Lab tests revealed that his cortisol levels were higher than normal, raising suspicion of Cushing’s disease. Initial pituitary imaging revealed slight structural changes, but no clear tumor signs.

Clinicians then performed the desmopressin stimulation test when she was 14 weeks pregnant. Simply put, this test involves administering desmopressin, a synthetic version of a hormone found naturally in the body that promotes the production of ACTH in people with Cushing’s disease, but not in those with others. diseases that cause increased levels of cortisol.

The results showed that 15 minutes after the administration of desmopressin, his ACTH levels increased by 70%. For background, in non-pregnant people, an increase of at least 35% is usually sufficient to confirm a diagnosis of Cushing.

Further imaging tests eventually identified the tumor, which was surgically removed when the patient was 18 weeks pregnant. She was put on cortisol supplements to keep hormone levels from dropping too low and given medication to manage blood pressure and blood sugar.

After 38 weeks of pregnancy, she gave birth to a boy who was a bit small for her gestational age, but otherwise healthy. After giving birth, her high blood pressure and abnormal blood sugar levels returned to normal.

A year later, the patient became pregnant again and delivered another baby after an uneventful pregnancy, with no signs of Cushing’s disease. Two years after the surgery, she stopped taking cortisol supplements.

“The results of the desmopressin stimulation test and pituitary MRI… suggested the diagnosis of [Cushing’s disease], which subsequently led to successful treatment, “the researchers wrote, adding that this test” may serve as a useful test to diagnose [Cushing’s disease] even in the context of pregnancy.

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