The longest reported survival of a child with McCune-Albright syndrome and a severe early presenting phenotype consisting of neonatal cushing syndrome, cardiac and liver diseases

Neonatal cushing syndrome (NCS) is a rare disease that results from prolonged exposure to high cortisol levels. McCune-Albright syndrome (MAS) is an exceedingly rare genetic disorder characterized by cafe-au-lait skin spots, bone fibrous dysplasia and multiple endocrinopathies. We describe a case of a premature neonate with Intrauterine Growth Retardation who presented with hypercortisolemia, neonatal transaminitis and cardiac dysfunction. Further evaluation revealed significant bilateral adrenal hyperplasia leading to the diagnosis of NCS as part of MAS. Despite maximum medical therapy, including metyrapone, the baby's refractory hypertension, hyperglycemia and persistent failure to thrive (weight of 1.4 kg at corrected age 38 weeks) necessitated bilateral adrenalectomy. This case did not initially demonstrate the classic MAS triad, notably, the absence of skeletal manifestations. There has been no previous description of a baby who has had all the early life-threatening features present and survived beyond 18 months. This case highlights the severity of the phenotype and the challenges involved in diagnosing and treating NCS and MAS in neonates.

Successful Management of a Ruptured Interstitial Pregnancy: A Case Report

Interstitial pregnancy is a rare entity that usually leads to the rupture of the uterus. The difficulty and delay in diagnosing this condition have been reported to cause high mortality rates. Here, we present the case of a 36-year-old woman who presented to the emergency department with severe epigastric pain and hemodynamic instability. Her current gestational age (GA) could not be accurately measured as she was unbooked and had irregular periods. However, by abdominal examination, the GA was estimated to be 38 weeks, whereas by ultrasound it was approximately 28 weeks. It was also noted that the uterus was empty, and the fetus was found in the abdominal cavity. Hence, a working diagnosis of uterine rupture was made and the patient was taken for emergency laparotomy. The patient delivered an alive 1.2 kg baby. Intraoperatively, the placenta was implanted in the interstitial part of the right fallopian tube. The placenta was then excised and right salpingectomy was performed, following which the abdomen was closed in layers. Postoperatively, the patient made an uneventful recovery and was discharged home in stable condition; however, the baby passed away due to complications related to extreme prematurity.