Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.
Front Endocrinol (Lausanne). 2024 Mar 12;15:1326496. doi: 10.3389/fendo.2024.1326496. eCollection 2024.
Cushing's syndrome (CS) during pregnancy is a rare endocrine disorder characterized by hypercortisolism, which is significantly associated with maternal-fetal complications. Despite its rarity, CS during pregnancy may be related to a high risk of complications for both the mother and fetus.The aim of the present case study is to update the diagnostic approach to CS during pregnancy and the therapeutic strategies for this medical condition to minimize maternal-fetal complications.
Here, we present two cases of CS in pregnant women, one of whom had twins. Typical clinical symptoms and signs of hypercortisolism developed at the beginning of pregnancy. The plasma cortisol diurnal rhythm of the pregnant patient was absent. CS was confirmed by cortisol and adrenocorticotropic hormone (ACTH) assessment, as well as imaging examination. We investigated the changes in the hypothalamic-pituitary-adrenal axis during normal pregnancy and the etiology, diagnosis and treatment of CS during pregnancy.
Due to the associated risks of laparoscopic adrenalectomy,it is uncertain whether this treatment significantly decreases overall maternal mortality. Additional observational research and validation through randomized controlled trials (RCTs) are required. We advise that CS in pregnant women be diagnosed and treated by experienced teams in relevant departments and medical centers.
妊娠合并库欣综合征（CS）是一种罕见的内分泌疾病，其特征为皮质醇增多症，与母婴并发症密切相关。尽管其发病率较低，但妊娠 CS 可能与母婴并发症的高风险有关。本病例研究旨在更新妊娠 CS 的诊断方法和治疗策略，以最大限度地减少母婴并发症。
我们在此介绍两例妊娠 CS 患者，其中 1 例为双胞胎。患者在妊娠早期出现典型的皮质醇增多症临床症状和体征。该孕妇的血浆皮质醇昼夜节律消失。通过皮质醇和促肾上腺皮质激素（ACTH）评估以及影像学检查证实 CS。我们研究了正常妊娠期间下丘脑-垂体-肾上腺轴的变化以及妊娠 CS 的病因、诊断和治疗。
由于腹腔镜肾上腺切除术相关的风险，尚不确定该治疗方法是否显著降低了总体产妇死亡率。需要进行更多的观察性研究和通过随机对照试验（RCT）进行验证。我们建议由相关科室和医疗中心的经验丰富的团队诊断和治疗妊娠 CS。
