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(TDO)
[1–3] [PREPRINTER stage]
Trop Doct OnlineFirst, published on May 14, 2015 as doi:10.1177/0049475515585641
Case Report
A rare case of Cushing’s syndrome in pregnancy
Tropical Doctor 0(0) 1–3 ! The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0049475515585641 tdo.sagepub.com
Parul Sinha1, Kumkum Srivastava2, Uma Gupta3 and Shalini Dwivedi4
Keywords Endocrine, pregnancy, diagnosis
Introduction We report a case of Cushing’s syndrome (CS) in pregnancy. CS occurs due to abnormal exposure to excess glucocorticoids for a prolonged duration which leads to significant consequences if not treated. Fortunately, it is rare in pregnancy because of the menstrual disturbances and infertility with which it is associated.1 Its rarity leads to a low degree of clinical suspicion, often delaying diagnosis more or less completely. When it does occur, a high rate of miscarriage or preterm delivery and even sudden intrauterine death may be expected. Maternal morbidity includes hypertension, preeclampsia, wound breakdown, diabetes, fracture and opportunistic infections.2,3
Case Report A 30-year-old multigravida patient, unbooked at 27 weeks of pregnancy, was admitted to the Emergency Department of Era’s Lucknow Medical College with chief complaints of generalised weakness and breathlessness for the previous 1 month. She was apparently asymptomatic until she experienced progressive increase in her body weight, raised blood pressure, deranged blood sugars and proteinuria. There were no similar complaints in the family. There was no past history of hypertension, diabetes, asthma and coagulopathy, intake of exogenous hormonal intake or steroid intake. On general examination, the patient was breathless, conscious and oriented, febrile, hypertensive (170/110 mmHg), tachycardic (130/min) and tachypnoeic (35/min). She had a BMI of 29.5 kg/m2, a moon face, hirsutism, purple striations all over the body, easy bruising, truncal obesity, severe pedal oedema and hyper pigmentation: in short, a classic appearance of CS. Investigations revealed an anaemia
(Hb 95 g/L), fasting blood sugar was 11.9 mmol/L and post prandial was 16.09 mmol/L. Serum total proteins were 54 g/L, albumin was 28 g/L, HBA1C was 8.1%, LDH was 1632 (normal range, 105–333 IU/L), 24 h urinary protein 2.40 g (normal,
(TDO)
[1–3] [PREPRINTER stage]
Trop Doct OnlineFirst, published on May 14, 2015 as doi:10.1177/0049475515585641
Case Report
A rare case of Cushing’s syndrome in pregnancy
Tropical Doctor 0(0) 1–3 ! The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0049475515585641 tdo.sagepub.com
Parul Sinha1, Kumkum Srivastava2, Uma Gupta3 and Shalini Dwivedi4
Keywords Endocrine, pregnancy, diagnosis
Introduction We report a case of Cushing’s syndrome (CS) in pregnancy. CS occurs due to abnormal exposure to excess glucocorticoids for a prolonged duration which leads to significant consequences if not treated. Fortunately, it is rare in pregnancy because of the menstrual disturbances and infertility with which it is associated.1 Its rarity leads to a low degree of clinical suspicion, often delaying diagnosis more or less completely. When it does occur, a high rate of miscarriage or preterm delivery and even sudden intrauterine death may be expected. Maternal morbidity includes hypertension, preeclampsia, wound breakdown, diabetes, fracture and opportunistic infections.2,3
Case Report A 30-year-old multigravida patient, unbooked at 27 weeks of pregnancy, was admitted to the Emergency Department of Era’s Lucknow Medical College with chief complaints of generalised weakness and breathlessness for the previous 1 month. She was apparently asymptomatic until she experienced progressive increase in her body weight, raised blood pressure, deranged blood sugars and proteinuria. There were no similar complaints in the family. There was no past history of hypertension, diabetes, asthma and coagulopathy, intake of exogenous hormonal intake or steroid intake. On general examination, the patient was breathless, conscious and oriented, febrile, hypertensive (170/110 mmHg), tachycardic (130/min) and tachypnoeic (35/min). She had a BMI of 29.5 kg/m2, a moon face, hirsutism, purple striations all over the body, easy bruising, truncal obesity, severe pedal oedema and hyper pigmentation: in short, a classic appearance of CS. Investigations revealed an anaemia
(Hb 95 g/L), fasting blood sugar was 11.9 mmol/L and post prandial was 16.09 mmol/L. Serum total proteins were 54 g/L, albumin was 28 g/L, HBA1C was 8.1%, LDH was 1632 (normal range, 105–333 IU/L), 24 h urinary protein 2.40 g (normal,
