Turakulov Republican Specialized Scientific and Practical Medical Center of Endocrinology of the Ministry of Health of the Republic of Uzbekistan, Tashkent, Republic of Uzbekistan

Authors

  • Z.Yu. Halimova Turakulov Republican Specialized Scientific and Practical Medical Center of Endocrinology of the Ministry of Health of the Republic of Uzbekistan, Tashkent, Republic of Uzbekistan http://orcid.org/0000-0002-3041-0268
  • O.B. Irgasheva Turakulov Republican Specialized Scientific and Practical Medical Center of Endocrinology of the Ministry of Health of the Republic of Uzbekistan, Tashkent, Republic of Uzbekistan

DOI:

https://doi.org/10.22141/2224-0721.16.4.2020.208483

Keywords:

Cushing’s syndrome, women, diagnosis, hormonal profile, reproductive disorders

Abstract

Background. Cushing’s syndrome is a severe neuro-endocrine pathology, which for many years has been under the scrutiny of many different specialists due to the diversity of its complications. Hyperandrogenism and menstrual irregularities, such as amenorrhea and oligomenorrhea, complement the clinical picture of Cushing’s syndrome. The purpose of the study was to assess the state of fertile function and hormonal profile in female patients with Cushing’s syndrome. Materials and methods. Under supervision, there were 163 patients of reproductive age with Cu­shing’s syndrome during the period from 2000 to 2019. Their average age was 27.58 ± 3.40 years (from 17 to 49 years), the duration of the disease was 4.2 ± 0.2 years. Twenty healthy women of the corresponding age made up the control group. Results. Patients with Cushing’s syndrome were distributed as follows: the first group with ACTH-dependent Cushing’s syndrome — 130 (79.7 %), the second group with ACTH-independent Cushing’s syndrome — 30 (18.4 %), and the third group with ACTH-ectopic Cushing’s syndrome — 3 (1.8 %) people. Among various reproductive disorders in patients with Cushing’s syndrome, menstrual disorders and secondary amenorrhea dominated. A significant decrease in basal levels of luteinizing and follicle-stimulating hormones, a reduction in ovarian hormones (estradiol, progesterone) against the background of hyperandrogenemia and a significant increase in blood cortisol levels, as well as increase in ACTH were characteristic of patients from the first group on the 14th day of the menstrual cycle. Hyperplasia of both adrenal glands was diagnosed in 110 (84.6 %) people with ACTH-dependent Cushing’s syndrome, nodular hyperplasia of both adrenal glands — in 13 (10 %), incidentaloma — in 3 (2.3 %), and nodular hyperplasia of one adrenal gland — in 2 (1.5 %). Conclusions. Reproductive disorders were observed in patients with Cushing’s syndrome: menstrual irregularities — in 32.9 %, secondary amenorrhea — in 20.4 % individuals. Most of the menstrual irregularities were found in the group of patients with ACTH-dependent Cushing’s syndrome. Menstrual irregularities manifested in the form of oligomenorrhea (30 % of cases), amenorrhea (35 %), polymenorrhea (7.5 %) and cycle variability (7.5 %).

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References

Sharma ST, Nieman LK, Feelders RA. Cushing's syndrome: epidemiology and developments in disease management. Clin Epidemiol. 2015;7:281-293. doi:10.2147/CLEP.S44336.

Feelders RA, Pulgar SJ, Kempel A, Pereira AM. The burden of Cushing's disease: clinical and health-related quality of life aspects. Eur J Endocrinol. 2012;167(3):311-326. doi:10.1530/EJE-11-1095.

Ntali G, Asimakopoulou A, Siamatras T, et al. Mortality in Cushing's syndrome: systematic analysis of a large series with prolonged follow-up. Eur J Endocrinol. 2013;169(5):715-723. doi:10.1530/EJE-13-0569.

Arnaldi G, Scandali VM, Trementino L, Cardinaletti M, Appolloni G, Boscaro M. Pathophysiology of dyslipidemia in Cushing's syndrome. Neuroendocrinology. 2010;92 Suppl 1:86-90. doi:10.1159/000314213.

Geer EB, Shen W, Strohmayer E, Post KD, Freda PU. Body composition and cardiovascular risk markers after remission of Cushing's disease: a prospective study using whole-body MRI. J Clin Endocrinol Metab. 2012;97(5):1702-1711. doi:10.1210/jc.2011-3123.

Macut D, Milutinović DV, Rašić-Marković A, Nestorov J, Bjekić-Macut J, Stanojlović O. A decade in female reproduction: an endocrine view of the past and into the future. Hormones (Athens). 2018;17(4):497-505. doi:10.1007/s42000-018-0073-x.

Brue T, Amodru V, Castinetti F. MANAGEMENT OF ENDOCRINE DISEASE: Management of Cushing's syndrome during pregnancy: solved and unsolved questions. Eur J Endocrinol. 2018;178(6):R259-R266. doi:10.1530/EJE-17-1058.

Cyranska-Chyrek E, Filipowicz D, Szczepanek-Parulska E, et al. Primary pigmented nodular adrenocortical disease (PPNAD) as an underlying cause of symptoms in a patient presenting with hirsutism and secondary amenorrhea: case report and literature review. Gynecol Endocrinol. 2018;34(12):1022-1026. doi:10.1080/09513590.2018.1493101.

Liao CC, Lin SY, Lin HW, et al. Menstrual abnormalities in a woman with ACTH-dependent pituitary macroadenoma mimicking polycystic ovary syndrome. Taiwan J Obstet Gynecol. 2006;45(2):176-179. doi:10.1016/S1028-4559(09)60221-7.

Szczepanek-Parulska E, Cyranska-Chyrek E, Nowaczyk M, et al. Diagnostic Difficulties In a Young Women With Symptoms of Cushing Syndrome. Endocr Pract. 2018;24(8):766. doi:10.4158/EP-2017-0257.

Sathyakumar S, Paul TV, Asha HS, et al. Ectopic cushing syndrome: a 10-year experience from a tertiary care center in southern india. Endocr Pract. 2017;23(8):907-914. doi:10.4158/EP161677.OR.

Ackerman KE, Misra M. Amenorrhoea in adolescent female athletes. Lancet Child Adolesc Health. 2018;2(9):677-688. doi:10.1016/S2352-4642(18)30145-7.

Holgado-Galicia MV, Magno JD, Acelajado-Valdenor C, Isip-Tan IT, Lim-Abrahan MA. Cushing's syndrome in pregnancy. BMJ Case Rep. 2011;2011:bcr0120113720. doi:10.1136/bcr.01.2011.3720.

Xu JJ, Wang YJ, Shan LZ, Gu W, Zeng WH. Recurrent ACTH-independent Cushing's syndrome in multiple pregnancies. Gynecol Endocrinol. 2013;29(4):309-310. doi:10.3109/09513590.2012.743014.

Nassi R, Ladu C, Vezzosi C, Mannelli M. Cushing's syndrome in pregnancy. Gynecol Endocrinol. 2015;31(2):102-104. doi:10.3109/09513590.2014.984680.

Tauchmanovà L, Pivonello R, Di Somma C, et al. Bone demineralization and vertebral fractures in endogenous cortisol excess: role of disease etiology and gonadal status. J Clin Endocrinol Metab. 2006;91(5):1779-1784. doi:10.1210/jc.2005-0582.

Lindsay JR, Jonklaas J, Oldfield EH, Nieman LK. Cushing's syndrome during pregnancy: personal experience and review of the literature. J Clin Endocrinol Metab. 2005;90(5):3077-3083. doi:10.1210/jc.2004-2361.

Published

2021-09-01

How to Cite

Halimova, Z., & Irgasheva, O. (2021). Turakulov Republican Specialized Scientific and Practical Medical Center of Endocrinology of the Ministry of Health of the Republic of Uzbekistan, Tashkent, Republic of Uzbekistan. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), 16(4), 310–315. https://doi.org/10.22141/2224-0721.16.4.2020.208483

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Section

Original Researches