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促肾上腺皮质激素依赖型周期性库欣综合征伴妊娠成功及产后早期复发

ACTH-dependent Cyclic Cushing Syndrome With Successful Pregnancy and Early Postpartum Relapse.

作者信息

Diah Mohd Idris Mohamad, Ho Jin Hui, Tee Hwee Ching

机构信息

Endocrinology and Diabetes Unit, Department of Medicine, Hospital Queen Elizabeth II, Kota Kinabalu 88300, Malaysia.

出版信息

JCEM Case Rep. 2025 Apr 11;3(5):luaf079. doi: 10.1210/jcemcr/luaf079. eCollection 2025 May.

Abstract

Cyclic Cushing syndrome (CS) is a rare form of CS characterized by intermittent episodes of hypercortisolism. We report the case of a 30-year-old female who was diagnosed with ACTH-dependent Cushing disease, confirmed by initial biochemical tests and pituitary imaging. Although surgery was planned, she experienced spontaneous remission for several months, followed by pregnancy, and subsequently relapsed in the early postpartum period. Transsphenoidal resection of a left-sided pituitary adenoma was then performed, confirming an ACTH-secreting tumor. A review of the literature revealed that this case contributes to the increasing number of patients with cyclic CS, with particular attention to the challenges of diagnosing hypercortisolism during pregnancy. While cases of Cushing disease recurrence after pituitary surgery in the immediate postpartum period have been documented, this is the first reported case of early postpartum relapse in cyclic CS. This case highlights the importance of long-term follow-up in patients with a high index of suspicion for cyclic CS, as well as the diagnostic challenges in managing the condition during pregnancy and the peripartum period.

摘要

周期性库欣综合征(CS)是一种罕见的CS形式,其特征为皮质醇增多症的间歇性发作。我们报告了一例30岁女性病例,该患者经初步生化检查和垂体成像确诊为促肾上腺皮质激素(ACTH)依赖性库欣病。尽管计划进行手术,但她经历了数月的自发缓解,随后怀孕,并在产后早期复发。随后进行了经蝶窦左侧垂体腺瘤切除术,证实为分泌ACTH的肿瘤。文献回顾显示,该病例增加了周期性CS患者的数量,尤其关注孕期诊断皮质醇增多症的挑战。虽然有文献记载垂体手术后在产后即刻库欣病复发的病例,但这是首次报道的周期性CS产后早期复发病例。该病例强调了对高度怀疑周期性CS的患者进行长期随访的重要性,以及在孕期和围产期管理该疾病时的诊断挑战。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/87ce/11986810/50ab595ffcb6/luaf079f1.jpg

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