Acth-Dependent Cushing Syndrome Caused by Thymic Carcinoid Diagnosed After Delivery of a Healthy Child

Abstract

Objective: Pregnancy with Cushing syndrome is generally rare, but it is common to have a baby with Cushing syndrome. However, there has been no report of an adrenocorticotropic hormone (ACTH)-producing carcinoid diagnosed promptly after delivery. We present the first report of a woman with untreated Cushing syndrome caused by an ACTH-producing thymic carcinoid who gave birth to a healthy child. Methods: A 21-year-old female underwent a caesarean section because of rupture of membranes at 31 weeks of pregnancy. Two months after delivery, she was aware of pedal edema, and it worsened rapidly. Two weeks later, she visited our hospital. Results: Endocrine examination revealed high levels of ACTH (527 pg/mL) and cortisol (113 μg/dL) that were not affected by overnight dexamethasone suppression tests. Subsequent chest and abdominal dynamic computed tomography showed a large mediastinal tumor (3.8 cm in diameter) and enlargement of the adrenal glands. Aided by the results of immunohistochemistry from a biopsy specimen, we made the diagnosis of ectopic ACTH-dependent Cushing syndrome, following which a tumorectomy was performed. The tumor was finally diagnosed as an atypical thymic carcinoid with positivity for synaptophysin, chromogranin A, and ACTH. Conclusion: We present the first report of a woman with untreated Cushing syndrome caused by an ACTH-producing thymic carcinoid who gave birth to a healthy child. Abbreviations: ACTH = adrenocorticotropic hormone; CS = Cushing syndrome; MEN1 = multiple endocrine neoplasia type 1