Department of Obstetrics and Gynecology, University of Ulm (Universitätsklinikum Ulm), Ulm, Germany.
Department of Obstetrics and Gynecology, Munich Klinik Harlaching (München Klinik Harlaching), Munich, Germany.
BMC Pregnancy Childbirth. 2020 Jul 25;20(1):421. doi: 10.1186/s12884-020-03117-1.
First manifestation of Cushing's syndrome during pregnancy is rare. The diagnosis of both Cushing's and primary aldosteronism within a pregnancy has not been previously documented. Diagnosis is especially challenging due to the normal physiological changes that occur during pregnancy. Consequently, many tests that are normally used for diagnosis are not reliable. Tumor based etiologies can be surgically removed. Etiologies that are not tumor based are challenging to treat during pregnancy.
A 25 year old G1P0 was admitted in the 22 week of pregnancy with elevated blood pressure (200/100 mm Hg), acne, moon facies, abdominal striae and hirsutism. With five antihypertensive medications her blood pressure remained 190/100 mm Hg. The patient was admitted to the ICU for intravenous medications and monitoring. She was diagnosed with Cushing's syndrome and primary aldosteronism. In spite of therapy with spironolactone and metyrapone she developed preeclampsia and was delivered in the 26 week of pregnancy. At her follow up visit eight weeks postpartum she had blood pressure within normal limits, no clinical signs or symptoms, and all medications had been discontinued.
Early diagnosis of pregnancy induced Cushing's syndrome and primary aldosteronism requires an interdisciplinary approach. Late detection has been associated with increased perinatal morbidity and mortality including but not limited to placental abruption and intrauterine demise. Collaboration is essential in the optimization of maternal and fetal outcomes.
库欣综合征在妊娠期间首次表现出来的情况较为罕见。在妊娠期间同时诊断出库欣综合征和原发性醛固酮增多症的情况此前尚未有过记载。由于妊娠期间会发生正常的生理变化，因此诊断特别具有挑战性。许多通常用于诊断的测试因此变得不可靠。基于肿瘤的病因可以通过手术切除。而那些非肿瘤病因的情况在妊娠期间很难治疗。
一名 25 岁的 G1P0 患者在妊娠 22 周时因血压升高（200/100mmHg）、痤疮、满月脸、腹部条纹和多毛症而入院。尽管使用了五种降压药物，她的血压仍保持在 190/100mmHg。患者被收入 ICU 进行静脉内药物治疗和监测。她被诊断为库欣综合征和原发性醛固酮增多症。尽管使用螺内酯和米托坦进行了治疗，但她还是出现了子痫前期，并在妊娠 26 周时分娩。在产后 8 周的随访时，她的血压恢复正常，没有任何临床症状或体征，所有药物都已停用。
妊娠引起的库欣综合征和原发性醛固酮增多症的早期诊断需要采取多学科方法。晚期发现与围产期发病率和死亡率增加有关，包括但不限于胎盘早剥和宫内死亡。协作对于优化母婴结局至关重要。
