Patients who have been successfully treated for Cushing’s disease with surgery may resume normal menstrual periods and become pregnant. Other patients may remain amenorrheic typically because the part of the pituitary that controls reproductive function may have been permanently disrupted by the original tumor, or more likely, by the surgery itself. In that case, treatment by an infertility specialist is needed to establish ovulation using exogenous (replacement) hormone therapy or other modalities.
During pregnancy, there are a number of increased hormone requirements so that patients who are receiving thyroid hormone replacement may need to have their dose of thyroid hormone adjusted. In a normal pregnancy, the adrenal gland production of cortisol markedly increases so that levels of cortisol are markedly increased. In women who become pregnant after successful pituitary surgery and have had return of normal adrenal function, the adrenal glands will respond normally to pregnancy and produce more cortisol as appropriate.
However, patients who have permanent adrenal insufficiency after surgery i.e. the pituitary hormone stimulating the adrenal glands (ACTH) is not secreted normally will require chronic glucocorticoid replacement and must be aware that their replacement dose of glucocorticoids will most likely need to be increased during the pregnancy. This will require careful monitoring to avoid adrenal insufficiency, which may be difficult to diagnose during pregnancy and to avoid too high a dose as well.
Women with a history of Cushing’s who do not require hormone replacement typically do not have additional concerns regarding nursing. Although the dose of thyroid hormone replacement may change post-partum in many women, there is no issue in regard to thryoid replacement and nursing. Women who require chronic glucocorticoids post-partum should check with their physician regarding nursing. Some women with hypopituitarism who do not have adequate pituitary prolactin secretion may have difficulty nursing. In addition, corticosteroids are secreted in breast milk. Prednisone is less likely than other corticosteroids to be secreted in breast milk. However, women who are receiving glucocorticoids, particularly those taking higher doses should be aware that it may pose a risk to the infant and should check with their pediatrician regarding nursing.
Author: Dr. Anne Klibanski MD (Prior to 2007)
Editor’s Note: Dr. Klibanski is the Chief of the Neuroendocrine Center at Massachuetts General Hospital in Boston, MA and has many years of experience with Cushing’s Syndrome.