Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Affiliated with Technion-Israel Institute of Technology, Haifa, Israel.
Eur J Obstet Gynecol Reprod Biol. 2012 Nov;165(1):1-7. doi: 10.1016/j.ejogrb.2012.05.030. Epub 2012 Jun 13.
We present a case of adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome diagnosed in a patient in the third trimester of her pregnancy, with an adrenal mass observed on imaging studies. Laparoscopic adrenalectomy was performed successfully at 32 weeks. To the best of our knowledge, this is the latest gestational age at which laparoscopic adrenalectomy has been reported. We present the various considerations for determining the surgical approach and the optimal timing for surgery. Adrenalectomy during pregnancy for the treatment of Cushing's syndrome caused by adrenocortical adenoma has been reported in 23 patients in the English-language medical literature to date and seems safe and beneficial. According to the data, surgical treatment has led to a reduction in perinatal mortality and maternal morbidity rates, but has not affected the occurrence of preterm birth and intrauterine growth restriction. The best outcome can be achieved by a multidisciplinary approach, with a team comprising a maternal-fetal medicine specialist, an endocrinologist and a surgeon. The timing of surgery and the surgical approach need to be determined according to the surgeon's expertise, the severity of the condition, the patient's preferences, and gestational age. Laparoscopy may prove to be the preferred surgical approach. The small number of cases precludes providing evidence-based recommendations.
我们报告了一例在妊娠晚期（第 32 周）诊断的促肾上腺皮质激素（ACTH）非依赖性库欣综合征病例，影像学检查发现肾上腺有肿块。腹腔镜肾上腺切除术成功完成。据我们所知，这是目前报道的腹腔镜肾上腺切除术的最晚妊娠周数。我们提出了确定手术方法和最佳手术时机的各种考虑因素。迄今为止，在英语医学文献中已报道了 23 例因肾上腺皮质腺瘤引起的库欣综合征孕妇行肾上腺切除术的病例，这种治疗似乎是安全且有益的。根据这些数据，手术治疗降低了围产期死亡率和产妇发病率，但并未影响早产和宫内生长受限的发生。多学科方法可获得最佳结果，团队由母胎医学专家、内分泌学家和外科医生组成。手术时机和手术方法需要根据外科医生的专业知识、病情严重程度、患者的偏好和妊娠周数来确定。腹腔镜检查可能被证明是首选的手术方法。由于病例数量较少，无法提供基于证据的建议。
