SAT-482 Adrenal Cushing Syndrome in Late Second Trimester Superimposed by Preeclampsia

Abstract Disclosure: Y. Abdullah: None. M. Barke: None. P.V. Kumar: None. M.N. Kulkarni-Date: None. A. Mody: None. Background: Cushing syndrome (CS) during pregnancy is remarkably rare, with an estimated incidence of less than one case per 100,000 pregnancies. Its clinical detection is often hindered by the physiologically elevated cortisol levels inherent to normal gestation. Consequently, important manifestations of pathologic hypercortisolism, such as hypertension, hyperglycemia, and weight gain, can be easily mistaken for routine or complicated pregnancy states (e.g., preeclampsia, gestational diabetes). Yet, failure to recognize and treat CS can lead to significant morbidity for both mother and fetus, particularly when it coexists with severe obstetric complications like preeclampsia. Clinical Case: In this report, we describe a 31-year-old gravida 3, para 1001 woman at 22.6 weeks of gestation who presented with refractory headaches and severe-range blood pressures. Physical examination was significant for persistent sinus tachycardia, posterior neck fat pad, and violaceous vertical striae on her abdomen and bilateral upper arms. Laboratory screening for preeclampsia revealed proteinuria but did not fully explain her severe presentation. Radiographic imaging revealed a 3.3×2.0 centimeter (cm) right adrenal mass, and biochemical evaluations confirmed CS (24-hour urine free cortisol values >1800 µg/day; normal range <45 µg/day). After multidisciplinary risk assessment by Maternal-Fetal Medicine, Antepartum Obstetrics, Endocrinology, Anesthesia, and Endocrine Surgery, the decision was made to proceed with surgical intervention at 25.5 weeks gestation.. She underwent a robotic-to-open right adrenalectomy despite her advanced gestational age with pathology confirming adrenal cortical hyperplasia. Perioperative monitoring included careful steroid tapering, blood pressure monitoring and close obstetric surveillance. Her blood pressures stabilized, and no further obstetric complications were observed. Discussion: Given the rarity of CS in pregnancy superimposed with preeclampsia, there is no consensus approach to management; treatment should be individualized to account for severity of hypercortisolism, trimester of pregnancy, risk of maternal-fetal harm, and the patient’s wishes. The literature is scarce with very few reports of CS superimposed with preeclampsia being treated with adrenalectomy during gestation. This case emphasizes that while gestational hypercortisolism confounds the diagnosis of CS, prompt recognition and definitive surgical management combined with meticulous multidisciplinary oversight can be lifesaving, particularly when faced with impending maternal-fetal compromise. Presentation: Saturday, July 12, 2025