Women's Clinical Management Group, Sidra Medicine, Doha, Qatar.
Department of Obstetrics and Gynaecology, Oman Medical College, Muscat, Oman.
J Obstet Gynaecol. 2020 Aug;40(6):749-758. doi: 10.1080/01443615.2019.1648395. Epub 2019 Aug 30.
Adrenal disorders may manifest during pregnancy for the first time, or present from before pregnancy as either undiagnosed or diagnosed and treated. They may present as hormonal hypofunction or hyperfunction, or with mass effects or other non-endocrine effects. Adrenal disorders such as Cushing's syndrome, Addison's disease, pheochromocytoma, primary hyper-aldosteronism and adreno-cortical carcinoma are rare in pregnancy. Pregnancy presents special problems in the evaluation of the hypothalamic-pituitary-adrenal and renin-angiotensin-aldosterone axis as these undergoe major changes during pregnancy. Diagnosis is challenging as symptoms associated with pregnancy are also seen in adrenal diseases. A timely diagnosis and treatment is critical as these disorders can cause maternal and foetal morbidity and mortality. A high index of suspicion must be maintained as they can go unrecognised and untreated. An early diagnosis and treatment often improves outcomes. The aim of this article is to review the patho-physiology, clinical manifestation, diagnosis and management of various adrenal disorders during pregnancy.
肾上腺疾病在妊娠期间可能首次出现，也可能在妊娠前就存在但未被诊断或已被诊断和治疗。它们可能表现为激素功能减退或功能亢进，或出现肿块效应或其他非内分泌效应。在妊娠期间，库欣综合征、艾迪生病、嗜铬细胞瘤、原发性醛固酮增多症和肾上腺皮质癌等肾上腺疾病较为罕见。由于妊娠期间下丘脑-垂体-肾上腺和肾素-血管紧张素-醛固酮轴发生重大变化，因此在评估这些轴时会出现特殊问题。由于与妊娠相关的症状也可见于肾上腺疾病，因此诊断具有挑战性。及时诊断和治疗至关重要，因为这些疾病会导致母亲和胎儿的发病率和死亡率。由于这些疾病可能未被识别和未得到治疗，因此必须保持高度怀疑。早期诊断和治疗通常可改善结局。本文旨在综述妊娠期间各种肾上腺疾病的病理生理学、临床表现、诊断和治疗。
