Department of Endocrinology , Hôpital Cochin, Assistance Publique Hôpitaux de Paris, 75014 Paris, France.
J Clin Endocrinol Metab. 2011 Apr;96(4):E658-62. doi: 10.1210/jc.2010-2235. Epub 2011 Feb 2.
Pituitary surgery is the first line of treatment for Cushing's disease; when surgery fails, bilateral adrenalectomy may be proposed, particularly for women with a desire for pregnancy. Little is known about the impact of pregnancy on corticotroph tumor progression after bilateral adrenalectomy.
The aim was to evaluate the impact of pregnancy on corticotroph tumor progression after bilateral adrenalectomy in Cushing's disease and to assess maternal and pregnancy outcomes.
We conducted a retrospective cohort study.
Patients who became pregnant after bilateral adrenalectomy were followed in a single center.
Twenty pregnancies from 11 patients with Cushing's disease were treated by bilateral adrenalectomy and no pituitary irradiation.
Corticotroph tumor progression was assessed by serial pituitary magnetic resonance imaging and plasma ACTH measurements before, during, and after pregnancy. Comparisons were performed using paired Wilcoxon rank tests. Data on maternal and neonatal outcomes were recorded by correspondence from patients and obstetricians.
Corticotroph tumor progression occurred in eight of 17 pregnancies, and ACTH increased in eight of 10 pregnancies. However, rates of increase during or after pregnancy were not faster than those observed before pregnancy. Maternal complications occurred in four pregnancies from two patients, including gestational hypertension in three and gestational diabetes mellitus in three. Among these four pregnancies, three had a favorable outcome, and one led to an in utero death after eclampsia, due to loss to follow-up. No other maternal or fetal complications were reported.
Pregnancy does not accelerate corticotroph tumor progression after bilateral adrenalectomy. Pregnancy is manageable, provided the patients can be followed closely.
对于库欣病，垂体手术是一线治疗方法；当手术失败时，可能会提出双侧肾上腺切除术，特别是对于有生育愿望的女性。关于双侧肾上腺切除术后妊娠对促肾上腺皮质激素细胞瘤进展的影响知之甚少。
旨在评估妊娠对双侧肾上腺切除术后库欣病促肾上腺皮质激素细胞瘤进展的影响，并评估母婴结局。
我们进行了一项回顾性队列研究。
在一个单中心，对双侧肾上腺切除术后怀孕的患者进行随访。
11 例库欣病患者中有 11 例患者在接受双侧肾上腺切除术和无垂体放疗后接受了 20 次妊娠治疗。
在妊娠前、妊娠中和妊娠后通过连续垂体磁共振成像和血浆 ACTH 测量评估促肾上腺皮质激素细胞瘤进展。使用配对 Wilcoxon 秩检验进行比较。通过与患者和产科医生的通信记录母婴结局数据。
在 17 次妊娠中，有 8 次发生促肾上腺皮质激素细胞瘤进展，在 10 次妊娠中有 8 次 ACTH 增加。然而，妊娠期间或之后的增加率并不快于妊娠前观察到的增加率。两名患者的 4 次妊娠出现了母体并发症，包括 3 例妊娠高血压和 3 例妊娠糖尿病。在这 4 次妊娠中，有 3 次结局良好，1 次因子痫导致宫内死亡，原因是失访。没有其他母婴并发症的报告。
妊娠不会加速双侧肾上腺切除术后促肾上腺皮质激素细胞瘤的进展。只要能够密切随访，妊娠是可以管理的。
