{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T18:17:50Z","timestamp":1783448270870,"version":"3.55.0"},"reference-count":24,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":2620,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/deed.en_GB"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,1,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>A 29-year-old G4A3 woman presented at 25 weeks of pregnancy with progressive signs of Cushing\u2019s syndrome (CS), gestational diabetes requiring insulin and hypertension. A 3.4\u2009\u00d7\u20093.3\u2009cm right adrenal adenoma was identified during abdominal ultrasound imaging for nephrolithiasis. Investigation revealed elevated levels of plasma cortisol, 24\u2009h urinary free cortisol (UFC) and late-night salivary cortisol (LNSC). Serum ACTH levels were not fully suppressed (4 and 5\u2009pmol\/L (N: 2\u201311)). One month post-partum, CS regressed, 24-h UFC had normalised while ACTH levels were now less than 2\u2009pmol\/L; however, dexamethasone failed to suppress cortisol levels. Tests performed in vivo 6 weeks post-partum to identify aberrant hormone receptors showed no cortisol stimulation by various tests (including 300\u2009IU hLH i.v.) except after administration of 250\u2009\u00b5g i.v. Cosyntropin 1\u201324. Right adrenalectomy demonstrated an adrenocortical adenoma and atrophy of adjacent cortex. Quantitative RT-PCR analysis of the adenoma revealed the presence of ACTH (MC2) receptor mRNA, while LHCG receptor mRNA was almost undetectable. This case reveals that CS exacerbation in the context of pregnancy can result from the placental-derived ACTH stimulation of MC2 receptors on the adrenocortical adenoma. Possible contribution of other placental-derived factors such as oestrogens, CRH or CRH-like peptides cannot be ruled out.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points:<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1530\/edm-18-0115","type":"journal-article","created":{"date-parts":[[2019,2,8]],"date-time":"2019-02-08T15:36:26Z","timestamp":1549640186000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":6,"title":["Exacerbation of Cushing\u2019s syndrome during pregnancy: stimulation of a cortisol-secreting adrenocortical adenoma by ACTH originating from the foeto-placental unit"],"prefix":"10.1530","volume":"2019","author":[{"given":"Matthieu","family":"St-Jean","sequence":"first","affiliation":[{"name":"Division of Endocrinology","department":["Department of Medicine and Research Center, Centre Hospitalier Universitaire de Montr\u00e9al, Montr\u00e9al, Qu\u00e9bec, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"MacKenzie-Feder","sequence":"additional","affiliation":[{"name":"Division of Endocrinology","department":["Department of Medicine and Research Center, Centre Hospitalier Universitaire de Montr\u00e9al, Montr\u00e9al, Qu\u00e9bec, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Bourdeau","sequence":"additional","affiliation":[{"name":"Division of Endocrinology","department":["Department of Medicine and Research Center, Centre Hospitalier Universitaire de Montr\u00e9al, Montr\u00e9al, Qu\u00e9bec, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Lacroix","sequence":"additional","affiliation":[{"name":"Division of Endocrinology","department":["Department of Medicine and Research Center, Centre Hospitalier Universitaire de Montr\u00e9al, Montr\u00e9al, Qu\u00e9bec, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2019,2,7]]},"reference":[{"key":"2026070713462144600_bib1","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":"2026070713462144600_bib2","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1210\/er.2004-0025","article-title":"The hypothalamic-pituitary-adrenal axis in pregnancy: challenges in disease detection and treatment","volume":"26","author":"Lindsay","year":"2005","journal-title":"Endocrine Reviews"},{"key":"2026070713462144600_bib3","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.beem.2018.01.003","article-title":"Aberrant G-protein coupled hormone receptor in adrenal 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