Cushing Syndrome Complicated by Multiple Pathological Spinal Fractures and Posterior Reversible Encephalopathy Syndrome in the Post-delivery Phase

Abstract

A 28-year-old female with central obesity, moon face and multiple sites of acne vulgaris began to experience generalized convulsions after complaining of severe back pain during hospitalization on post-first-delivery day 5. After an infusion of diazepam, she showed severe hypoxia and underwent tracheal intubation. She had a history of gestational diabetes mellitus (DM), acne vulgaris, osteoporosis and thoracolumbar fracture. She also felt severe back pain after falling down two weeks previously and underwent Caesarean section. Her blood pressure was remained 100–160 mmHg during the perinatal period. Whole body computed tomography revealed bilateral low density in the parieto-occipital white matter, bilateral aspirated lesions in her lungs, and enlargement of the right adrenal gland. The tentative diagnosis was posterior reversible encephalopathy syndrome (PRES) with convulsion, aspirated pneumonia and Cushing syndrome with DM and pathological fracture due to osteoporosis. She underwent an infusion of levetiracetam, sedatives, analgesics and a depressor were administered to control blood pressure strictly. She was extubated two days after her respiratory function showed improvement. After controlling her pain and treating osteoporosis, a blood test was compatible with Cushing syndrome. She finally underwent adenectomy in four months. Pathology was adenoma. This is a rare case of Cushing syndrome complicating pathological spinal fractures and PRES in the post-delivery phase. Aggressive control of pain and blood pressure in the perinatal period may be required to prevent the onset of PRES.