Sridharan Kalyani, Sahoo Jayaprakash, Palui Rajan, Patil Milind, Kamalanathan Sadishkumar, Ramesh A S, Kubera N S
Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Endocrinology and Metabolism, Jawaharlal Institute of Post Graduate Medical Education and Research, Dhanvanthri Nagar, Puducherry, India.
Pituitary. 2021 Oct;24(5):670-680. doi: 10.1007/s11102-021-01142-7. Epub 2021 Mar 29.
We report a case of a pregnant woman with Cushing's disease (CD) and performed a systematic review of literature on diagnosis, treatment, maternal and fetal outcomes of CD in pregnancy.
A PubMed search was performed for manuscripts in English language from inception till June 2020. Cases of CD with hypercortisolism during pregnancy were included and categorized into three groups based on treatment received. Data on diagnostic modalities, CD remission, materno-fetal outcomes were analysed.
Fifty-five patients of CD with 62 pregnancies were analysed. 24-h urinary free cortisol(UFC) was elevated by a mean of 5.4 ± 4.2 fold upper limit of normal non-pregnant level. 12/19 (63.1%) CD patients had more than threefold elevation of UFC measured during pregnancy. Mean midnight serum cortisol was 753.7 ± 270.5 nmol/l. At a midnight serum cortisol cut off of 440 nmol/l, 15/16 patients were correctly identified as CD. 23.2% underwent trans-sphenoidal surgery (group 1), 16.1% received only medical treatment (group 2) while 60.7% received no treatment (group 3) during pregnancy. Remission rates for CD in groups 1 and 2 were 76.9% and 77.8%, respectively. Adverse maternal and fetal outcomes were seen in 53.9% and 59.3% of the patients, respectively and were not significantly different between groups, although, lesser live births and greater pregnancy losses were seen in group 3.
Midnight serum cortisol had better sensitivity than UFC for diagnosing hypercortisolism due to CD during pregnancy. In general, CD should be treated during pregnancy in order to optimize maternal and fetal outcomes as a trend towards increased live births is seen in treated subjects.
我们报告一例患有库欣病（CD）的孕妇病例，并对妊娠期间CD的诊断、治疗、母婴结局的文献进行系统综述。
对截至2020年6月的英文手稿进行PubMed检索。纳入孕期皮质醇增多症的CD病例，并根据接受的治疗分为三组。分析诊断方式、CD缓解情况、母婴结局的数据。
分析了55例患有CD的患者的62次妊娠。24小时尿游离皮质醇（UFC）平均升高至正常非妊娠水平上限的5.4±4.2倍。12/19（63.1%）的CD患者在孕期测量的UFC升高超过三倍。午夜血清皮质醇平均为753.7±270.5nmol/l。午夜血清皮质醇临界值为440nmol/l时，15/16例患者被正确诊断为CD。23.2%的患者接受经蝶窦手术（第1组），16.1%仅接受药物治疗（第2组），而60.7%在孕期未接受治疗（第3组）。第1组和第2组CD的缓解率分别为76.9%和77.8%。分别有53.9%和59.3%的患者出现不良母婴结局，各组之间无显著差异，尽管第3组活产较少且妊娠丢失较多。
午夜血清皮质醇对诊断孕期因CD导致的皮质醇增多症比UFC具有更好的敏感性。总体而言，孕期应治疗CD以优化母婴结局，因为接受治疗的患者有活产增加的趋势。
