Endoscopic sclerotherapy in extrahepatic portal hypertension in pregnancy

Article Abstract:

Extrahepatic portal hypertension is a condition in which the portal vein, which brings blood from digestive and other internal organs to the liver, becomes obstructed, leading to increased pressure in the vein. Although most patients with this disorder come to medical attention in childhood or adolescence, some reach adulthood and become pregnant. These pregnant women may be in danger, since one complication of the disease is the formation of esophageal varices (enlarged veins in the esophagus, the muscular tube through which food passes between the mouth and stomach). These esophageal varices may rupture, causing life-threatening bleeding. A case report is presented of a 23-year-old woman, 35 weeks' pregnant, who developed bloody vomiting (hematemesis). The patient had received a diagnosis of portal vein thrombosis (blood clot in the portal vein) at the age of 15, and had been surgically treated for variceal bleeding. In the current episode, bed rest and antacids were prescribed after examination showed two thrombotic varices but no further bleeding. Two weeks later, a cesarean section was performed because of an increase in blood pressure; a healthy baby was delivered. Eighteen months later, the patient became pregnant again. Hematemesis was treated by sclerotherapy, a process carried out via the endoscope (a tube for viewing the esophagus) to stop the variceal bleeding. No new varices developed in this pregnancy, and another healthy infant was delivered by cesarean section at 37 weeks' gestation (again, because of elevated blood pressure). A brief review of the medical literature is presented concerning treatment of pregnant women with extrahepatic portal hypertension. Sclerotherapy is recommended in patients who meet certain criteria. Although earlier viewpoints held that patients with this condition should not become pregnant, it is now less risky to do so, providing careful monitoring is available during pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Complications and side effects, Portal hypertension, Sclerotherapy

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Spontaneous resolution of Cushing's syndrome after pregnancy

Article Abstract:

Cushing's syndrome develops when there is a excess of cortisol, a hormone produced by the adrenal gland. Women with Cushing's syndrome rarely are able to become pregnant. One month after a 27-year-old healthy woman became pregnant, she developed a round face, hair growth, acne, weight gain (particularly in the neck and abdomen), and increased bruising and purplish stretch marks on the abdomen, all symptoms of Cushing's syndrome. The patient subsequently developed moderate gestational diabetes, sugar intolerance that can occur during pregnancy. A five-pound infant was delivered by cesarean section. Computerized tomography, a detailed cross-sectional X-ray used to visualize internal structures, showed an enlarged pituitary gland during the pregnancy. After delivery the symptoms of Cushing's syndrome had improved and the pituitary gland returned to normal size. Adrenocorticotropic hormone-dependent disease was diagnosed because there was no tumor in the adrenal gland. It is thought that another hormone, the corticotropin-releasing hormone produced by the placenta, may have played a role in exacerbating Cushing's syndrome during pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Causes of, Development and progression, ACTH, Corticotropin

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Cushing's syndrome and pregnancy

Article Abstract:

Cushing's syndrome results from an overproduction of glucocorticoid hormones by the adrenal glands, and is caused either directly by a tumor of the adrenals, or indirectly by overstimulation resulting from a tumor in the pituitary. Since women with Cushing's syndrome often have amenorrhea, or the lack of menstruation, pregnancy is not common. A review of 67 cases of pregnant women with Cushing's syndrome reveals a remarkably varied clinical picture. Although there is a relative infrequency of Cushing's disease occurring among pregnant women, the diagnosis may be delayed since some of the symptoms, such as hypertension and hyperglycemia, occur commonly in pregnancy. The outcome of Cushing's syndrome pregnancies ranges from early spontaneous abortion to uncomplicated full term birth. Although premature labor is common among these patients, both premature labor and fetal loss were less common among women who had been treated surgically for Cushing's syndrome. Since surgery poses a hazard to both mother and fetus, and drug therapy may be dangerous to the fetus, each case must be considered and managed individually. (Consumer Summary produced by Reliance Medical Information, Inc.)

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