A rare occurrence of Premature Birth and Recurrent Acute Pulmonary Oedema in the mother due to Cushing’s Syndrome: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#Presentation of Cushing’s syndrome during pregnancy is extremely rare. We report a 21-year-old female with Cushing’s syndrome diagnosed at 23 weeks of gestation and had recurrent acute pulmonary oedema during the antepartum and postpartum period. She delivered prematurely via emergency caesarean section at 28 weeks of gestation. This case highlights the rare occurrence of recurrent acute pulmonary oedema during pregnancy and consequential premature birth in a patient with adrenal Cushing’s. She was diagnosed with adrenal Cushing’s during the postpartum period based on unsuppressed serum cortisol after overnight and low-dose dexamethasone suppression test with a suppressed ACTH. CT scan of the adrenal glands revealed a right adrenal cortical adenoma. The risk of complications in infants and mothers who suffer from Cushing’s syndrome needs to be handled carefully. The diagnosis of Cushing’s syndrome in pregnant women often overlaps and is difficult to establish in early pregnancy.

Near death 18 weeks preeclampsia in molar pregnancy

Authors present a case of a molar pregnancy of 18 weeks with preeclampsia complicated with acute pulmonary oedema. A condition carrying a significant risk to mother, therefore, raising an important issue on preeclampsia symptoms on pregnancies before 20 weeks. A 31-year-old woman gravida 2, parity 1 presented with dyspnea at 18 weeks' gestation. Blood pressure was very high (180/110 mmHg) and there was markedly proteinuria (+4). She had severe dyspnea and her oxygen saturation level was 75%. Her chest X-ray graph showed massive acute pulmonary oedema. Ultrasonography shows endometrial cavity containing multiple small cystic spaces, creating a characteristic “snowstorm” and “cluster of grapes” appearance. Markedly elevated quantitative human chorionic gonadotropin (250.000 mIU/mL). The acute pulmonary oedema has been managed by diuretics (Furosemide) and oxygen. There was no cardiac abnormalities in the tranthoracic echocardiogram. Authors administered antihypertensive therapy (intravenous nicardipine and lmethyldopa in per os), and magnesium sulfate in prevention of eclamptic seizures. The pregnancy was terminated by uterine evacuation under oxytocin infusion by manual ultrasound aspiration. She was followed up intensive care unit for two days. Causes of secondary high blood pressure had been eliminated. The patient's blood pressure rapidly normalized two days after delivery. Dyspnea disappeared one day later. Pathologic and cytogenetic analyses revealed a complete hydatiform mole. Two days after delivery; the serum β-hCG level was 99000 mlU/ml. A control ultrasonography shows an empty uterus. Hydatidiform mole is classified into 2 different subtypes, complete hydatidiform mole and partial or incomplete hydatidiform mole development of preeclampsia prior to 20 weeks of gestation should prompt a clinical evaluation to exclude the possibility of an underlying hydatidiform molar pregnancy. Ultrasonography and level of serum BHCG are the initial investigation of choice for the detection of hydatidiform mole. Aspiration is the treatment of reference.

Valvuloplastia mitral percutánea de emergencia en un paciente con edema pulmonar refractario / Emergency percutaneous mitral valvuloplasty in a patient with refractory pulmonary oedema

Resumen La estenosis mitral usualmente es causada por fiebre reumática. A pesar de ser una patología poco frecuente en los países desarrollados, es prevalente en los países en vía de desarrollo, donde aproximadamente dos tercios de la población mundial vive, haciendo de esta condición, una enfermedad valvular común. Es importante considerar la estenosis mitral en el diagnóstico diferencial de los pacientes con edema agudo de pulmón cardiogénico refractario y la valvuloplastia mitral percutánea de emergencia como el tratamiento definitivo. Se presenta el caso de un paciente femenino de 21 años, con edema agudo de pulmón cardiogénico refractario, secundario a estenosis mitral muy severa de origen reumático, tratado con valvuloplastia percutánea con balón de urgencia. Se realiza una revisión sobre la estenosis mitral y se examina el tratamiento con especial énfasis en los casos publicados en la literatura de valvuloplastia mitral percutánea de emergencia.

Abstract Mitral valve stenosis is usually caused by rheumatic fever. Although it is an uncommon disease in developed countries, it is prevalent in developing countries where approximately two-thirds of the world population lives, making this condition a common valve disease. It is important to consider mitral stenosis in the differential diagnosis of patients with acute refractory cardiogenic pulmonary oedema, and emergency percutaneous mitral valvuloplasty as the definitive treatment. The case is presented of a 21 year-old female with acute refractory cardiogenic pulmonary oedema, secondary to a very severe mitral stenosis of rheumatic origin, and who was treated with an urgent percutaneous balloon valvuloplasty. A review of mitral stenosis is presented, and the treatment is examined, with special emphasis on cases of emergency percutaneous mitral valvuloplasty published in the literature.