SAT-426 - ACTH-INDEPENDENT CUSHING'S SYNDROME ASSOCIATED WITH BILATERAL ADRENAL ADENOMAS DIAGNOSED DURING PREGNANCY: A CASE REPORT

Background: Adrenocorticotropic hormone (ACTH)-independent Cushing’s syndrome associated with bilateral adrenal adenomas is rare, and its diagnosis during pregnancy is exceptionally uncommon and clinically challenging. Physiological changes in pregnancy may obscure biochemical evaluation, while diagnostic and therapeutic options are limited. Determining the source of cortisol hypersecretion in the presence of bilateral adrenal masses is essential for appropriate management.

Case presentation: We report the case of a 41-year-old pregnant woman with a history of type 2 diabetes mellitus and polycystic ovary syndrome who presented at 24 weeks of gestation with uncontrolled hyperglycemia, hypertension, and hypokalemia. Hormonal evaluation demonstrated hypercortisolemia with suppressed ACTH levels, and abdominal magnetic resonance imaging revealed bilateral adrenal masses. Because of pregnancy-related constraints, intensive medical therapy was initiated to control hypercortisolism-related comorbidities, allowing safe continuation of pregnancy until cesarean delivery at 36 weeks of gestation. Postpartum reassessment confirmed persistent ACTH-independent Cushing’s syndrome. Neither low-dose nor high-dose dexamethasone suppression tests suppressed serum cortisol levels. Adrenal computed tomography showed bilateral adrenal adenomas. Adrenal venous sampling demonstrated lateralized cortisol secretion from the left adrenal gland. The patient subsequently underwent laparoscopic left adrenalectomy, and histopathology confirmed an adrenocortical adenoma. Postoperatively, serum cortisol levels normalized, and her clinical features, hypertension, and glycemic control improved significantly.

Conclusions: ACTH-independent Cushing’s syndrome with bilateral adrenal adenomas during pregnancy is extremely rare and poses major diagnostic and therapeutic challenges. Medical management may serve as an effective bridging strategy to achieve disease control until delivery. In the postpartum setting, adrenal venous sampling is a valuable tool for localizing cortisol hypersecretion and guiding definitive surgical management.

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