Cushing's Disease in Pregnant Women When Medical Therapy Has Not Controlled Cortisol

This protocol applies to pregnant women, or women planning a pregnancy, with Cushing's disease in whom the initial medical therapy did not achieve adequate cortisol control at the pregnancy-adjusted target.

Clinical scenario

The patient is pregnant or actively planning pregnancy with confirmed Cushing's disease. Because normal cortisol levels are higher during pregnancy, treatment targets are adjusted to a higher cut-off — and failure to meet even that modified threshold indicates the need for a different approach.

Prior treatment — target not achieved

Medical therapy (cabergoline or metyrapone) was used in this pregnancy context, with cortisol targeted to a higher pregnancy-adjusted threshold of 1.5 × the upper limit of normal. Cortisol was not controlled to that cut-off, prompting escalation to the current protocol.

Next-line approach (partial overview)

When medical therapy has failed in this setting, a surgical intervention is among the approaches considered — one that several expert centers specifically recommend at an earlier stage of disease for women with pregnancy plans. The complete step-by-step protocol is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/S2213-8587(21)00235-7

In pregnant women or those desiring pregnancy, consider cabergoline or metyrapone, although no CD medications are approved for use in pregnancy.

Many expert centers recommend BLA earlier in the course of the disease for females with CD desiring pregnancy.

This may make BLA a preferred option in female patients with an immediate pregnancy plan.

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