Cushing ’s Syndrome is rare in pregnancy; the available literature consists of case reports and small case series. The diagnosis of Cushing’s in pregnancy can be difficult as some normal phenomena of pregnancy including weight gain, abdominal striae and a tendency to hyperglycaemia and idiopathic hypertension of pregnancy, are all features shared with Cushing’s syndrome. Diagnosis and treatment are important as the presence of Cushing’s entails considerable maternal and foetal risk. Once suspected, the screening tests for Cushing’s, all of which entail confirmation of hypercortisolism, need to be interpreted in the light of the physiologic hypercortisolism of pregnancy. These tests include 24 hour urine free cortisol, the 1mg overnight dexamethasone suppression test and late night salivary cortisol. 24 hour urine free cortisol levels are elevated up to 2 to 3-fold during pregnancy but can be much higher in Cushing’s during pregnancy although there is overlap. Cushing’s has a predilection towards unilateral adrenal secretory autonomy. This may reflect the tendency to hyperandrogenism in pituitary Cushing’s, the commonest cause in non-pregnant cases, where hyperandrogenism may reduce fertility. Once diagnosed, the options are generally for adrenal or pituitary surgery as ectopic Cushing’s is very rare in pregnancy. Surgery is generally performed in the second trimester to reduce the risk of premature delivery and other untoward outcomes. Medical treatment of Cushing’s is an option and Metyrapone has been used with some success. Many cases of successful management have been reported and application of the general principles of Cushing’s management with an appreciation for the altered hypothalamic-pituitary-adrenal axis and particular risks of treatments in pregnancy should optimise outcomes.