O-08 A CASE OF BILATERAL MICRONODULAR ADRENAL DISEASE PRESENTING WITH PREGNANCY-INDUCED CUSHING SYNDROME

Abstract Introduction Pregnancy-induced Cushing syndrome (CS) is an extremely rare entity. Its recognition is crucial due to significant maternal-fetal morbidity. Among ACTH-independent causes, bilateral micronodular adrenal disease (Primary Pigmented Nodular Adrenocortical Disease-PPNAD) is usually associated with Carney complex (CNC) and PRKAR1A mutations. However, about 10%–20% of patients can also present without CNC features. Diagnosing PPNAD can be challenging in the absence of overt Cushingoid features and typical imaging findings. Clinical Case A 32-year-old woman was referred for the investigation of possible pregnancy-induced CS. She had the story of second-trimester miscarriage due to severe preeclampsia 10 months before admission. She described cushingoid physical features during pregnancy that vanished following fetal loss. She was nulliparous and her sister also reported to experience gestational CS with preterm deliveries. Several paternal female cousins had similar stories. She was normotensive on bisoprolol 10mg/day, and her physical examination reminded any sign of hypercortisolism. Pregnancy was excluded and hormonal evaluation at follicular phase of the menstrual cycle revealed; suppressed ACTH levels,