PDF(Pubmed)
Abstract：
CONCLUSIONS: Cushing\'s syndrome is an endocrine disorder that causes anovulatory infertility secondary to hypercortisolism; therefore, pregnancy rarely occurs during its course. We present the case of a 24-year-old, 16-week pregnant female with a 10-month history of unintentional weight gain, dorsal gibbus, nonpruritic comedones, hirsutism and hair loss. Initial biochemical, hormonal and ultrasound investigations revealed hypokalemia, increased nocturnal cortisolemia and a right adrenal mass. The patient had persistent high blood pressure, hyperglycemia and hypercortisolemia. She was initially treated with antihypertensive medications and insulin therapy. Endogenous Cushing\'s syndrome was confirmed by an abdominal MRI that demonstrated a right adrenal adenoma. The patient underwent right laparoscopic adrenalectomy and anatomopathological examination revealed an adrenal adenoma with areas of oncocytic changes. Finally, antihypertensive medication was progressively reduced and glycemic control and hypokalemia reversal were achieved. Long-term therapy consisted of low-dose daily prednisone. During follow-up, despite favorable outcomes regarding the patient\'s Cushing\'s syndrome, stillbirth was confirmed at 28 weeks of pregnancy. We discuss the importance of early diagnosis and treatment of Cushing\'s syndrome to prevent severe maternal and fetal complications.
CONCLUSIONS: Pregnancy can occur, though rarely, during the course of Cushing\'s syndrome. Pregnancy is a transient physiological state of hypercortisolism and it must be differentiated from Cushing\'s syndrome based on clinical manifestations and laboratory tests. The diagnosis of Cushing\'s syndrome during pregnancy may be challenging, particularly in the second and third trimesters because of the changes in the maternal hypothalamic-pituitary-adrenal axis. Pregnancy during the course of Cushing\'s syndrome is associated with severe maternal and fetal complications; therefore, its early diagnosis and treatment is critical.
CONCLUSIONS: Pregnancy can occur, though rarely, during the course of Cushing\'s syndrome. Pregnancy is a transient physiological state of hypercortisolism and it must be differentiated from Cushing\'s syndrome based on clinical manifestations and laboratory tests. The diagnosis of Cushing\'s syndrome during pregnancy may be challenging, particularly in the second and third trimesters because of the changes in the maternal hypothalamic-pituitary-adrenal axis. Pregnancy during the course of Cushing\'s syndrome is associated with severe maternal and fetal complications; therefore, its early diagnosis and treatment is critical.
摘要：
结论：库欣综合征是一种内分泌紊乱，可引起继发于皮质醇增多症的无排卵性不孕；因此，怀孕期间很少发生。我们提出一个24岁的案例，怀孕16周的女性，有10个月的意外体重增加史，背肌,非瘙痒性粉刺,多毛症和脱发。初始生化，激素和超声检查显示低钾血症，夜间皮质醇血症增加和右肾上腺肿块。病人有持续性高血压,高血糖和皮质醇血症。她最初接受降压药和胰岛素治疗。内源性库欣综合征通过腹部MRI证实，显示右侧肾上腺腺瘤。该患者接受了右腹腔镜肾上腺切除术，解剖病理学检查显示肾上腺腺瘤伴嗜酸细胞改变。最后,抗高血压药物逐渐减少，血糖控制和低钾血症逆转。长期治疗包括每日低剂量泼尼松。随访期间,尽管患者的库欣综合征有良好的结果，在怀孕28周时确认了死产。我们讨论了库欣综合征的早期诊断和治疗对预防严重的母婴并发症的重要性。
结论：可以怀孕，虽然很少,在库欣综合征的过程中。妊娠是皮质醇增多症的一种短暂生理状态，必须根据临床表现和实验室检查与库欣综合征区分开来。怀孕期间库欣综合征的诊断可能具有挑战性，特别是在妊娠中期和中期，因为母体下丘脑-垂体-肾上腺轴的变化。库欣综合征过程中的妊娠与严重的母体和胎儿并发症有关；因此，其早期诊断和治疗至关重要。
结论：可以怀孕，虽然很少,在库欣综合征的过程中。妊娠是皮质醇增多症的一种短暂生理状态，必须根据临床表现和实验室检查与库欣综合征区分开来。怀孕期间库欣综合征的诊断可能具有挑战性，特别是在妊娠中期和中期，因为母体下丘脑-垂体-肾上腺轴的变化。库欣综合征过程中的妊娠与严重的母体和胎儿并发症有关；因此，其早期诊断和治疗至关重要。
