Tait D L, Williams J, Sandstad J, Lucci J A
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA.
Am J Perinatol. 1997 Sep;14(8):461-4. doi: 10.1055/s-2007-994180.
Cystic lesions of the adrenal gland are uncommon, most often diagnosed incidentally during diagnostic imaging or autopsy. An adrenal cyst presenting as a pelvic mass in pregnancy offers the clinician a diagnostic and therapeutic dilemma. A 28-year-old black female presented for routine obstetric care at 26 weeks' gestation and was found on examination to have a 40-cm pelvic-abdominal mass. Ultrasound confirmation revealed the mass to be cystic and arising from the right pelvis. Laboratory tests including hematocrit, white blood cell count, electrolytes, rapid plasma reagin (RPR), and CA-125 were within normal limits. The patient underwent exploratory laparotomy and a 40 x 20 cm right adrenal cyst was identified and resected. Postoperatively, the patient developed preterm labor and delivered a 955-g infant; the infant was discharged home 3 months later with bronchopulmonary dysplasia and delayed developmental milestones. The woman was discharged home without complication on postoperative Day 8. Accurate preoperative determination of the origin of a pelvic mass occurring in pregnancy is helpful in timing therapeutic intervention. Use of ultrasound and magnetic resonance imaging (MRI) modalities can provide detailed anatomical information without risk to mother or fetus. Conservative management of adrenal cyst in pregnancy may lower the morbidity and mortality of the mother and fetus.
肾上腺囊性病变并不常见，大多是在诊断性影像学检查或尸检时偶然发现。孕期出现的肾上腺囊肿表现为盆腔肿块，这给临床医生带来了诊断和治疗上的难题。一名28岁的黑人女性在妊娠26周时前来进行常规产科检查，检查发现其盆腔及腹部有一个40厘米的肿块。超声检查确认该肿块为囊性，起源于右盆腔。包括血细胞比容、白细胞计数、电解质、快速血浆反应素（RPR）和CA - 125在内的实验室检查结果均在正常范围内。患者接受了剖腹探查术，发现并切除了一个40×20厘米的右肾上腺囊肿。术后，患者出现早产，产下一名955克的婴儿；婴儿3个月后出院，患有支气管肺发育不良和发育里程碑延迟。该女性在术后第8天无并发症出院。准确术前确定孕期盆腔肿块的来源有助于安排治疗干预的时机。使用超声和磁共振成像（MRI）检查手段可提供详细的解剖信息，且对母亲和胎儿均无风险。孕期肾上腺囊肿的保守治疗可能会降低母亲和胎儿的发病率和死亡率。
