Pregnancy in Cushing's disease shortly after treatment by gamma-knife radiosurgery

Gamma-knife radiosurgery (GKR) is considered as a possible treatment for patients affected by unsuccessfully surgically treated pituitary adenoma or not suitable for surgery. The disadvantages of this technique seem to be the length of time to the onset of remission, which is known to be at least of 6 months, and the possible adverse effects. We report here a case of a 13-yr-old female patient with Cushing's disease (CD) due to ACTH-secreting pituitary adenoma. After a complete clinical remission obtained by a transsphenoidal surgery, at the age of 18, the patient had a recurrence of ACTH-dependent hypercortisolism, and a second transsphenoidal surgery was performed. In April 1999, a second recurrence of CID was diagnosed and the patient underwent GKR on a small pituitary mass, on the left side of the sella. In June 1999 amenorrhoea appeared, and in August 1999 pregnancy occurred. Although during the pregnancy the disease activity was still high, the fetus's growth was normal and in February 2000 a normal male infant was delivered. The baby and the mother did not show any biochemical signs or clinical symptoms of hypo- or hypercortisolism. This case is interesting, since GKR exerted a very rapid effect and turned to be safe even if performed shortly before pregnancy. Moreover, in spite of the still high disease activity, the pregnancy had a normal course and the fetus did not have any cortisol secretion abnormalities.