PMC5677213_01
Pregnancy induced CS: clinical symptoms, timeline, computed tomography, and histology. Pregnancy-induced CS (A). A 22-year-old pregnant woman (gravida 1, 21 weeks GA) presented with arterial hypertension, diabetes mellitus, acne (A; black arrow), hirsutism, edema, purple striae distensae (stretch marks) (A; black arrows), and moon face. (B) Schematic timeline view from diagnosis to bilateral adrenalectomy (ADX). (C and D) Abdominal computed tomography and adrenal volumetry showed bilateral enlarged adrenals that normalized after parturition. (E-G) Histopathology with hematoxylin and eosin staining of right adrenal (E) showed hyperplasia with large spongiocytic lipid-loaded cells of the adrenal cortex (F) and clusters of small compact ectopic cortical cells infiltrating the medulla (G). Scale bars, 1000 microm (E) and 50 microm (F and G).
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A 22-year-old primigravid woman at 21 weeks gestational age (GA) presented with signs and symptoms of CS (Fig. 1). Computed tomography showed bilaterally enlarged adrenals, but no nodular structures [Fig. 1(C) and 1(D)]. Acne suggesting hyperandrogenism (Fig. 1(A); ], insulin-dependent diabetes mellitus, and hypokalemic hypertension were prominent. At 25 weeks GA, preterm labor resulted in the vaginal delivery of a male child (sex chromosomes XY) [Fig. 1(B)]. Biochemical changes and adrenal volume had normalized 49 days after parturition (Table 3; Fig. 1(C) and 1(D)]. At week 51 [Fig. 1(B)] the patient presented with renewed signs and symptoms of CS, including an increased 24-hour urinary free cortisol excretion [999.4 microg/24 h (2757 nmol/d); upper limit of normal, 176 microg/24 h (485.6 nmol/d)] and a concurrent plasma hCG concentration of 2634 IU/L. Four weeks later [Fig. 1(B)] the patient underwent bilateral adrenalectomy at her request to achieve a normal pregnancy.