Leiba S, Weinstein R, Shindel B, Lapidot M, Stern E, Levavi H, Rusecki Y, Abramovici A
Department of Endocrinology, Beilinson Medical Center, Petah-Tikva, Israel.
Ann Endocrinol (Paris). 1989;50(1):49-53.
We hereby present a patient with Cushing's disease who became pregnant while being treated with o,p'-DDD and underwent a therapeutic abortion in view of the known embryotoxicity and placental transfer of this drug. Biopsy of adipose tissue in this patient showed it to be the storage site of considerable quantities of o,p'-DDD. Serum levels of o,p'-DDD determined in this patient initially four months after withdrawal of treatment and in another similar case three months after withdrawal were about 20 times higher than those found in untreated patients and reached control values only about 20 months later. Repeated evaluation of plasma and urinary free cortisol failed to reveal any correlation with the serum levels of o,p'-DDD, suggesting that the drug blood values cannot be used as a reliable indicator of the therapeutic effect on the adrenal gland. The histopathological examination of the embryo, aged about 42 days, revealed a dysmorphogenic event in the cortical primordia characterized by pycnotic sympathoblasts. It is suggested that such a toxic effect of o,p'-DDD on the embryonic cortical cells may act indirectly, affecting the viability of the migrating sympathoblasts.
我们在此报告一例库欣病患者，该患者在接受邻对滴滴滴（o,p'-DDD）治疗期间怀孕，鉴于该药物已知的胚胎毒性和胎盘转运情况，遂接受了治疗性流产。对该患者的脂肪组织活检显示，其为大量邻对滴滴滴的储存部位。该患者在停药四个月后首次测定的邻对滴滴滴血清水平，以及另一例类似患者在停药三个月后测定的水平，比未治疗患者的水平高出约20倍，且仅在约20个月后才恢复到对照值。对血浆和尿游离皮质醇的反复评估未能发现与邻对滴滴滴血清水平有任何相关性，这表明该药物的血药浓度不能用作肾上腺治疗效果的可靠指标。对约42天龄胚胎的组织病理学检查显示，皮质原基存在畸形发生事件，其特征为固缩的成神经细胞。有人提出，邻对滴滴滴对胚胎皮质细胞的这种毒性作用可能是间接的，影响了迁移中成神经细胞的活力。
