TABLE 3.

Summary of medical treatment used for the management of Cushing's syndrome in pregnancy

Drug	Benefits	Risks and limitations
Metyrapone 31 , 35 , 70 , 74 , 75 , 76 , 78	Quick onset of action	Increased 11‐deoxycorticosterone increases risk of hypertension, pre‐eclampsia, oedema, hypokalaemia Not available universally Crosses placenta – may affect foetal adrenal steroidogenesis
Cabergoline 80 , 82 , 83 , 84	Evidence from pregnant women with prolactinoma to support its safety in pregnancy	Disrupts lactation Only four cases, two for which other treatment was used Limited efficacy when used outside of pregnancy
Ketoconazole 6 , 70 , 74 , 79 , 80 , 81	Efficacious outside of pregnancy	Teratogenic in animal studies (not seen in humans) Potential for foetal feminisation in males in first trimester Risk of severe liver injury
Cyproheptadine 87 , 88 , 89	Use not recommended	Low efficacy Hyperphagia, weight gain, somnolence reported No longer recognised as a treatment for Cushing's syndrome
Mitotane 85 , 86	Use not recommended	Teratogenic
Aminoglutethimide 6	Use not recommended	Foetal masculinisation