Cushing's syndrome during pregnancy secondary to adrenal adenoma

Pregnancy rarely occurs in untreated cases of Cushing's syndrome [CS], because most of them are infertile due to significant maternal and fetal complications during pregnancy. Diagnosis of CS may be difficult during pregnancy. Since physiological changes of pregnancy are overlapped by classical presentation and biological confirmation of CS. Therefore the high clinical suspicious is needed for diagnosis. We present a 33 years old pregnant woman with a history of chronic hypertension from 10 years ago that referred to Imam Khomeini hospital for uncontrolled hypertension, gestational diabetes and fetal tachycardia at the 30 weeks of gestation. After initial studies abdominal MRI detected a 43 x 35 x 29 mm right adrenal mass. She was treated by anti-hypertensive drugs. But at 31.5 weeks of gestational age cesarean section was performed due to sever preeclampsia. Then two weeks after delivery open right adrenalectomy was carried out without any complications and in the histopathological evaluation benign adrenocortical adenoma was reported. CS is associated with considerable fetal and maternal morbidity and mortality. Selection of treatment method is variable and it depends on gestational age. Medical and surgical approaches have been used in managing CS in pregnancy. Surgical treatment is the first choice for CS which is recommended at the second trimester and in the late pregnancy medical treatment is preferred

[Comparing sexual function in normal women and women having undergone vaginoplasty for rokitansky syndrome]

Aplasia of the uterus and upper two-thirds of the vagina due to Mayer-Rokitansky-Kuster-Hauser syndrome prevents normal coitus which may lead to anxiety and other psychiatric problems in these women. Vaginal reconstruction improves the patients' quality of life. This study intends to compare sexual function in normal women and women having undergone vaginoplasty for Mayer-Rokitansky-Kuster-Hauser syndrome. This descriptive and analytical study was carried out in the gynecologic clinic of Imam Khomeini Hospital in 2004 to 2008. Nineteen female patients with Mayer-Rokitansky-Kuster-Hauser syndrome and a history of vaginoplasty were compared to 30 women without any anatomical malformations in their genitalia. The female sexual function index [FSFI] was used to evaluate the problem in the two groups. The calculated scores of the two groups were compared and statistically analyzed. The mean age of the patients was 29.57 [SD = 6.11] years. The mean score for sexual desire in individuals with a history of vaginoplasty was 22.84 [SD = 2.5] compared to 24.63 [SD = 2.94] in the healthy women [p = 0.033] and the mean score for sexual arousal in women having undergone vaginoplasty was 13.89 [SD = 2.47] compared to 15.27 [SD = 3.41] in the healthy individuals. Sexual arousal, orgasm and pain were not different between the two groups. Sexual arousal and satisfaction were not different in women having undergone vaginoplasty and women with normal sexual function. It seems that the surgery offers a better quality of life and is acceptable to women with Mayer-Rokitansky-Kuster-Hauser syndrome