Benothman W, Saad G, Kacem M, Ach K
Endocrinology Unit, Department of Endocrinology, Farhat Hached University Hospital, Avenue Ibn El Jazzar, Sousse 4000, Tunisia.
Case Rep Endocrinol. 2021 Feb 13;2021:5517303. doi: 10.1155/2021/5517303. eCollection 2021.
The association of pregnancy and Cushing's disease (CD) is rare. A 28-year-old woman was admitted for clinical suspicion of Cushing's syndrome. The investigations confirmed the diagnosis of CD with secondary hypogonadotropic hypogonadism due to an invasive pituitary macroadenoma. The patient underwent transsphenoidal adenomectomy, and histopathology showed an adrenocorticotropic hormone pituitary adenoma. Initial remission of CD ensued, and fertility was restored as the patient had 2 uncomplicated pregnancies. Five years and 10 months after surgery, a third spontaneous pregnancy was confirmed with underlying recurrent CD. Having mild hypercortisolism, CD was managed expectantly. The outcome was a healthy full-term neonate with no maternal complications during pregnancy or labor. Our case highlights the challenge faced by physicians of choosing the optimal approach to active CD in pregnancy. In cases where maternal and fetal complications are mild, conservative approach may be used and specific treatment can be postponed until after delivery.
妊娠与库欣病（CD）的关联较为罕见。一名28岁女性因临床怀疑库欣综合征入院。检查确诊为CD，伴有因侵袭性垂体大腺瘤导致的继发性低促性腺激素性性腺功能减退。患者接受了经蝶窦腺瘤切除术，组织病理学显示为促肾上腺皮质激素垂体腺瘤。CD最初缓解，患者恢复生育能力并顺利经历了2次妊娠。术后5年10个月，确诊第三次自然妊娠合并复发性CD。鉴于存在轻度皮质醇增多症，对CD采取了观察等待的处理方式。结果是产下一名健康的足月新生儿，孕期及分娩过程中未出现母体并发症。我们的病例凸显了医生在为孕期活动性CD选择最佳治疗方法时面临的挑战。在母婴并发症较轻的情况下，可采用保守方法，将特定治疗推迟至分娩后进行。
