What is essential is invisible to the eye

Abstract

A 30 year-old woman was transferred to our Department from the Department of Gynaecology and Obstetrics, where she was admitted for preeclampsia complicated by HELLP syndrome and had undergone therapeutic abortion during the first trimester of pregnancy. She was thereafter diagnosed to have an ACTH-independent Cushing’s syndrome, due to an adrenocortical mass.

Hypertension is a common condition during pregnancy and is associated with adverse maternal and perinatal outcomes. It can occur in women with pre-existing chronic hypertension, but can also manifest itself in the second half of pregnancy as new-onset hypertension. The high blood pressure can be due to an underlying cause, but among the possible causes Cushing’s syndrome (CS) is very rare during pregnancy, because most of CS patients are infertile. Furthermore, the diagnosis of CS is challenging during pregnancy, because its clinical features may simulate the physiological changes of pregnancy, especially in young women. The case herein reported emphasizes the key role of taking a detailed history and a thorough physical examination for the correct diagnosis, avoiding unnecessary and expensive investigations, and reducing the risk of complications related to a late diagnosis. We herein report also a reappraisal of the prevalence of hypertensive disorders during pregnancy and of the pathophysiology and diagnosis of CS in pregnancy.