Cushings syndrome in pregnancy is rare. This is explained by the syndromes association with amencerhea, infertility and abortions. Matemal and fetal risks increase markedly when pregnancy does occur in woman with hypercortisolism. Since pregnant women without Cushings syndrome develop some features of Cushings syndrome, such as hypertension, hyperglycemia and striae, a high index of clinical suspician must be maintained to prevent delay in diagnosis. The physiologic changes in adrenocorticostemid metabolism during pregnancy further complieate the diagnosis. We describe a case of Cushings syndmme in pregnancy secondary to an adrenal cortical adenoma which was diagnosed immediately after a preterm delivery in 24-year-old woman with preeclampsia.
Adenoma* ; Adrenocortical Adenoma ; Cushing Syndrome* ; Diagnosis ; Female ; Humans ; Hyperglycemia ; Hypertension ; Infertility ; Metabolism ; Pre-Eclampsia ; Pregnancy* ; Pregnant Women ; Young Adult

OBJECTIVETo investigate the expression of placenta-derived RASSF1A gene in maternal plasma during first and second trimesters, and to explore its value for the prediction of pre-eclampsia.

METHODSFor 325 pregnant women of the first trimester, free DNA of plasma samples was extracted at 7-12, 13-18, and 19-24 gestational weeks, respectively. Methylation-sensitive restriction enzyme digestion followed by fluorescence quantitative PCR (MSRE+ PCR) was employed for analyzing the concentrations of hypermethylated RASSF1A gene. Blood pressure, proteinuria and clinical feature were monitored at the same time. Those who had subsequently developed pre-eclampsia were selected as the pre-eclamptic group, 30 normal pregnant women were selected as the control group. Hypermethylated RASSF1A gene in maternal plasma was retrospectively analyzed. The relationship between clinical classification, type of pre-eclampsia and concentrations of the gene were further analyzed.

RESULTSTwenty-six out of the 325 pregnant women developed pre-eclampsia as their only complication. At 13-18 gestational weeks, the mean concentrations of fetus-specific RASSF1A sequences were 141.62 copies/mL in maternal plasma of pre-eclamptic pregnancies, which was significantly greater than that of the controls (98.90 copies/mL). Fetus-derived RASSF1A levels were 2.03 fold higher in pre-eclamptic subjects than controls at 19-24 gestational weeks. There was a significant difference in the level of hypermethylated RASSF1A gene between the mild and severe pre-clamptic subjects at 13-24 gestational weeks (P< 0.05). The concentrations of the sequences were significantly higher in early-onset severe pre-eclampsia than late-onset severe pre-eclampsia at 19-24 gestational weeks (P< 0.05).

CONCLUSIONAltered expression of hypermethylated RASSF1A gene may be detected in maternal plasma during second trimester, which has important significance for early prediction of pre-eclampsia.

Female ; Gestational Age ; Humans ; Placenta ; metabolism ; Pre-Eclampsia ; blood ; diagnosis ; genetics ; metabolism ; Predictive Value of Tests ; Pregnancy ; Pregnancy Trimester, Second ; Prenatal Diagnosis ; methods ; Tumor Suppressor Proteins ; blood ; genetics

Pregnancy induced hypertension is multifaceted syndrome with variable involvement of several key organ systems, so sensitive and specific laboratory tests for predicting severity and prognosis. and early diagnosis of this disease are required. Because heme catabolism results in equimolar production of carboxyhemoglobin, iron and bilirubin, a concomittant rise of these parameters would provide confirmation of increased heme catabolism. Microangiopathic hemolytic anemia may occurs in severe preeclampsia, but it is not known whether increased red cell turnover - occurs with mild preeclampsia as complication. The purpose of this study was to confirm that increased heme catabolism also occurs in patients with mild preeclampsia. The analysis of data was done on 23 cases with mild preeclampsia and 35 normal pregnant women, who were admitted to Yeungnam University Hospital from October 1992 to March 1993. The results were as follows. 1. The mean antepartum serum iron concentration was significantly higher in the group with mild preeclampsia (86.5+/-6.1 microg/dl) than in the controls (53.2+/-5.3 microg/dl). 2. The mean antepartum and postpartum carboxyhemoglobin concentrations were significantly higher in the group with mild preeclampsia (antepartum : 2.55+/-0.42 mg/dl, postpartum 1.21+/-0.4 mg/dl) than the controls (antepartum : 0.61+/-0.2 mg/dl, postpartum 0.53+/-0.2 mg/dl) 3. During postpartum, carboxyhemoglobin concentration in preeclampsia reduced significantly from antepartum level, but there was no difference between antepartum and postpartum carboxyhemoglobin concentrations among controls. 4. Bilirubin concentrations were similiar in both groups
Anemia, Hemolytic ; Bilirubin ; Carboxyhemoglobin* ; Early Diagnosis ; Female ; Heme ; Humans ; Hypertension, Pregnancy-Induced ; Iron* ; Metabolism ; Postpartum Period ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women ; Prognosis

The purpose of this study was to determine whether the levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and placenta growth factor (PlGF) are altered during the second trimester in the plasma of women who subsequently develop preeclampsia. We performed a case-control study to compare the levels of sFlt-1 and PlGF in the preeclamptic (n=46) and normal pregnant women (n=100). The maternal plasma levels of sFlt-1 and PlGF were measured by enzyme-linked immunosorbent assay. The sFlt-1 levels were significantly higher in the preeclamptic women than in normal controls (p<0.001), while the PlGF levels were significantly lower (p<0.001). In normal controls, sFlt-1 levels were positively correlated (r=0.27, p=0.008), whereas, in the preeclamptic women, those were negatively correlated with the PlGF levels (r=-0.423, p=0.005). Furthermore, the log[sFlt-1/PlGF] ratio was significantly higher in the preeclamptic women than in normal controls (p<0.001). The receiver operating characteristic curve revealed a specificity of 78% with a diagnostic sensitivity of 80.4%; the optimal cut-off value of the log[sFlt-1/PlGF] ratio was 1.4 (95% CI 0.756-0.910, p<0.001). Preeclampsia showed a strong association with increased levels of sFlt-1 and decreased levels of PlGF in the second trimester maternal plasma. Accordingly, the sFlt-1/PlGF ratio may provide early prediction of subsequent development of preeclampsia.
Adult ; Biological Markers/metabolism ; Case-Control Studies ; Female ; Humans ; Immunoassay ; Middle Aged ; Placenta/metabolism ; Pre-Eclampsia/*diagnosis/*metabolism ; Pregnancy ; Pregnancy Proteins/*biosynthesis ; Pregnancy Trimester, Second ; ROC Curve ; Sensitivity and Specificity ; Vascular Endothelial Growth Factor Receptor-1/*biosynthesis

OBJECTIVE: Gestational diabetes mellitus is defined as carbohydrate intolerance of variable severity first diagnosed during pregnancy. It is associated with adverse outcomes of pregnancy including obstetrical complications such as increased rate of cesarean sections, preeclampsia, and birth trauma, and perinatal morbidities, such as macrosomia, hypoglycemia, hypocalcemia, and hyperbilirubinemia. Therefore, screening for gestational diabetes mellitus and early diagnosis of this condition allows intervention to be carried out, thereby, the reduction of the untoward effects mentioned above can be minimized. METHODS: Screening for abnormal glucose metabolism was carried out in 489 pregnant women. A 50-g oral glucose load without regard to time of day or last meal, and a 1-hour plasma glucose determination with a threshold of 140mg/dl were used as a glucose screening test(GST). Patients with an abnormal GST underwent an oral glucose tolerance test(GTT). RESULTS: The overall incidence of gestational diabetes was 2.7%. The occurrence of this disorder was significantly related to the age of pregnant women, parity, or the presence of risk factors for gestational diabetes and obesity(Body Mass Index> or =26kg/m2). CONCLUSION: This study suggests that Korean pregnant women should be screened for gestational diabetes.
Blood Glucose ; Cesarean Section ; Diabetes, Gestational* ; Early Diagnosis ; Female ; Glucose Tolerance Test ; Glucose* ; Humans ; Hyperbilirubinemia ; Hypocalcemia ; Hypoglycemia ; Incidence ; Mass Screening* ; Meals ; Metabolism ; Parity ; Parturition ; Pre-Eclampsia ; Pregnancy ; Pregnant Women ; Prenatal Diagnosis* ; Risk Factors

Preeclapsia (PE) is a severe disorder that occurs during pregnancy, leading to maternal and fetal morbidity and mortality. PE affects about 3-8% of all pregnancies. In this study, we conducted liquid chromatographymass spectrometry/mass spectrometry (LC-MS/MS) to analyze serum samples depleted of the six most abundant proteins from normal and PE-affected pregnancies to profile serum proteins. A total of 237 proteins were confidently identified with < 1% false discovery rate from the two groups of duplicate analysis. The expression levels of those identified proteins were compared semiquantitatively by spectral counting. To further validate the candidate proteins with a quantitative mass spectrometric method, selective reaction monitoring (SRM) and enzyme linked immune assay (ELISA) of serum samples collected from pregnant women with severe PE (n = 8) or normal pregnant women (n = 5) was conducted. alpha2-HS-glycoprotein (AHSG), retinol binding protein 4 (RBP4) and alpha-1-microglobulin/bikunin (AMBP) and Insulin like growth factor binding protein, acid labile subunit (IGFBP-ALS) were confirmed to be differentially expressed in PE using SRM (P < 0.05). Among these proteins, AHSG was verified by ELISA and showed a statistically significant increase in PE samples when compared to controls.
Adult ; Alpha-Globulins/metabolism ; Amino Acid Sequence ; Biological Markers/blood ; Blood Proteins/*analysis ; Case-Control Studies ; Female ; Humans ; Insulin-Like Growth Factor Binding Proteins/blood ; Molecular Sequence Data ; Pre-Eclampsia/*blood/diagnosis ; Pregnancy ; Proteome/*analysis ; Retinol-Binding Proteins, Plasma/metabolism ; alpha-2-HS-Glycoprotein/metabolism