{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:51:17Z","timestamp":1782489077256,"version":"3.54.5"},"reference-count":20,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,3,6]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>We report a rare case of Cushing\u2019s syndrome in a pregnant woman carrying twins. Interestingly, the patient did exhibit many of the classic clinical features typically associated with hypercortisolism, including Cushingoid facies, violaceous striae, insulin-dependent diabetes, raised central adiposity, chronic hypertension and peripheral myopathy. Her case was less straightforward given her previous gastric sleeve bariatric surgery, which led to rapid weight loss prior to pregnancy. The occurrence of an atraumatic fracture of the femoral neck in a young woman with a medical history of type 2 diabetes mellitus, chronic hypertension and possible severe osteoporosis raised clinical suspicion of a unifying diagnosis, prompting further evaluation.<\/jats:p>\n                  <jats:p>Biochemical testing, including elevated cortisol and suppressed adrenocorticotropic hormone levels, alongside imaging studies, confirmed the diagnosis of adrenal Cushing\u2019s syndrome. This case prompted a deeper investigation into the physiological changes of the hypothalamic-pituitary-adrenal axis during normal pregnancy, as well as the unique challenges in diagnosing and managing Cushing\u2019s syndrome during pregnancy.<\/jats:p>\n                  <jats:p>This case highlights the need for a high index of suspicion and a multidisciplinary approach in diagnosing and managing complex presentations in pregnancy. Early recognition and treatment of Cushing\u2019s syndrome are critical to optimising maternal and fetal outcomes.<\/jats:p>\n                  <jats:p>Cushing\u2019s syndrome during pregnancy is a rare but serious hormonal syndrome characterised by elevated cortisol levels. This hypercortisolism may be a result of functional adrenal or pituitary tumours, or iatrogenic. Though uncommon, it poses a significant threat to both maternal and fetal health due to the high risk of complications. This case study aims to provide a current overview of the diagnosis and management of Cushing\u2019s syndrome in pregnancy, with an emphasis on minimising associated maternal and fetal morbidity. The case report highlights missed differential diagnoses of Cushing\u2019s syndrome in the pre-pregnancy period despite the presence of type 2 diabetes, hypertension and morbid obesity in a young patient. Bariatric surgery further complicated the differential diagnosis.<\/jats:p>","DOI":"10.1136\/bcr-2025-270637","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T14:10:15Z","timestamp":1775484615000},"page":"e270637","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic challenges of Cushing\u2019s syndrome in pregnancy"],"prefix":"10.1136","volume":"19","author":[{"given":"Fariha","family":"Tahir","sequence":"first","affiliation":[{"name":"Obstetrics and Gynaecology, Watford General Hospital, Watford, UK"},{"name":"West hertfordshire teaching hospitals and Trust, Watford, hertfordshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan","family":"Browne","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Watford General Hospital, Watford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melina","family":"Kostoula","sequence":"additional","affiliation":[{"name":"Watford General Hospital, Watford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anku","family":"Mehta","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Watford General Hospital, Watford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"2026062608153257000_19.4.e270637.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61375-1"},{"key":"2026062608153257000_19.4.e270637.2","doi-asserted-by":"crossref","unstructured":"Hakami OA , Ahmed S , Karavitaki N . Epidemiology and mortality of Cushing\u2019s syndrome. Best Pract Res Clin Endocrinol Metab 2021;35. doi:10.1016\/j.beem.2021.101521","DOI":"10.1016\/j.beem.2021.101521"},{"key":"2026062608153257000_19.4.e270637.3","doi-asserted-by":"crossref","first-page":"996","DOI":"10.4103\/2230-8210.122608","article-title":"Pregnancy and pituitary disorders: Challenges in diagnosis and management","volume":"17","author":"Laway","year":"2013","journal-title":"Indian J Endocr Metab"},{"key":"2026062608153257000_19.4.e270637.4","doi-asserted-by":"publisher","DOI":"10.1210\/er.2004-0025"},{"key":"2026062608153257000_19.4.e270637.5","doi-asserted-by":"crossref","unstructured":"Ildefonso-Najarro SP , Plasencia-Due\u00f1as EA , Benites-Moya CJ , et al . Pregnancy during the course of Cushing\u2019s syndrome: a case report and literature review. Endocrinol Diabetes Metab Case Rep 2020;2020. doi:10.1530\/EDM-20-0022","DOI":"10.1530\/EDM-20-0022"},{"key":"2026062608153257000_19.4.e270637.6","doi-asserted-by":"publisher","DOI":"10.1210\/jc.83.9.3083"},{"key":"2026062608153257000_19.4.e270637.7","doi-asserted-by":"crossref","DOI":"10.1111\/jne.13175","article-title":"Cardiovascular complications of Cushings syndrome: Impact on morbidity and mortality","volume":"34","author":"Clayton","year":"2022","journal-title":"J Neuroendocrinol"},{"key":"2026062608153257000_19.4.e270637.8","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-17-0263"},{"key":"2026062608153257000_19.4.e270637.9","doi-asserted-by":"crossref","unstructured":"Zhang X , Liao H , Zhu X , et al . A successful pregnancy in a patient with secondary hypertension caused by adrenal adenoma: a case report. BMC Pregnancy Childbirth 2019;19. doi:10.1186\/s12884-019-2262-2","DOI":"10.1186\/s12884-019-2262-2"},{"key":"2026062608153257000_19.4.e270637.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02242-X"},{"key":"2026062608153257000_19.4.e270637.11","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1007\/s12020-016-1117-0","article-title":"Cushing\u2019s syndrome and pregnancy outcomes: a systematic review of published cases","volume":"55","author":"Caimari","year":"2017","journal-title":"Endocrine"},{"key":"2026062608153257000_19.4.e270637.12","doi-asserted-by":"crossref","unstructured":"Holgado-Galicia MVB , Magno JD , Acelajado-Valdenor C , et al . Cushing\u2019s syndrome in pregnancy. BMJ Case Rep 2011;2011. doi:10.1136\/bcr.01.2011.3720","DOI":"10.1136\/bcr.01.2011.3720"},{"key":"2026062608153257000_19.4.e270637.13","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-2361"},{"key":"2026062608153257000_19.4.e270637.14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ecl.2005.09.010","article-title":"Adrenal disorders in pregnancy","volume":"35","author":"Lindsay","year":"2006","journal-title":"Endocrinol Metab Clin North Am"},{"key":"2026062608153257000_19.4.e270637.15","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1111\/cen.12853","article-title":"The morning and late-night salivary cortisol ranges for healthy women may be used in pregnancy","volume":"83","author":"Ambroziak","year":"2015","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2026062608153257000_19.4.e270637.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2011.08.004"},{"key":"2026062608153257000_19.4.e270637.17","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s11102-019-01004-3","article-title":"Surgical indications for pituitary tumors during pregnancy: a literature review","volume":"23","author":"Graillon","year":"2020","journal-title":"Pituitary"},{"key":"2026062608153257000_19.4.e270637.18","doi-asserted-by":"crossref","unstructured":"Li S , Yang C , Fan J , et al . Pregnancy-induced Cushing\u2019s syndrome with an adrenocortical adenoma overexpressing LH\/hCG receptors: a case report. BMC Endocr Disord 2020;20. doi:10.1186\/s12902-020-0539-0","DOI":"10.1186\/s12902-020-0539-0"},{"key":"2026062608153257000_19.4.e270637.19","doi-asserted-by":"crossref","unstructured":"Hamblin R , Coulden A , Fountas A , et al . The diagnosis and management of Cushing\u2019s syndrome in pregnancy. J Neuroendocrinol 2022;34. doi:10.1111\/jne.13118","DOI":"10.1111\/jne.13118"},{"key":"2026062608153257000_19.4.e270637.20","unstructured":"Google image of cushing syndrome illusion."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-270637","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:21:26Z","timestamp":1782487286000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-270637"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":20,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,6]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bcr-2025-270637"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-270637","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}