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目的:探讨妊娠合并肾上腺腺瘤导致库欣综合征的诊断和治疗。方法:回顾性分析在我院诊治的2例妊娠合并库欣综合征患者的病例资料。1例为28岁孕妇,孕23周(孕中期);1例为24岁孕妇,孕34周(孕晚期)。患者具有典型库欣的临床表现和体征,血ACTH<5pg/ml,24小时尿游离皮质醇明显增高,血皮质醇昼夜节律消失,大小剂量地塞米松抑制试验不被抑制。腹部MRI确诊为库欣腺瘤,2例均位于右侧肾上腺,大小分别为38mm×22mm和32mm×26mm。结果:1例患者于孕25周全麻下行腹腔镜右侧肾上腺肿瘤切除术,于孕35周顺利产一健康男婴。另1例在孕34周行剖宫产手术产一健康男婴,同时行腹腔镜肾上腺肿瘤切除术。术后病理证实为肾上腺皮质腺瘤。结论:妊娠期库欣综合征诊断有一定的困难。快速体重增加、四肢肌肉萎缩、向心性肥胖和腹部紫纹均提示库欣综合征的可能。24小时尿游离皮质醇检测是最佳的筛选检查。腹膜后腹腔镜手术安全有效,推荐手术时机为孕中期。
Objective: To investigate the diagnosis and treatment of Cushing’s syndrome caused by adrenal adenoma during pregnancy. Methods: Two cases of patients with Cushing’s syndrome during pregnancy were analyzed retrospectively. One case was a 28-year-old pregnant woman with 23 weeks of gestation (second trimester), one 24-year-old pregnant with 34 weeks of gestation (third trimester of pregnancy). Patients with typical Cushing’s clinical manifestations and signs of blood ACTH <5pg / ml, 24 hours urinary free cortisol was significantly increased, blood cortisol circadian rhythm disappeared, the dose of dexamethasone suppression test was not inhibited. Abdominal MRI diagnosis of Cushu adenoma, 2 cases are located in the right adrenal, the size was 38mm × 22mm and 32mm × 26mm. Results: One patient underwent laparoscopic right adrenalectomy under general anesthesia at 25 weeks of gestation. A healthy baby boy was successfully delivered at 35 weeks gestation. Another case of cesarean section in 34 weeks of pregnancy to produce a healthy baby boy, while laparoscopic adrenalectomy. Postoperative pathology confirmed adrenocortical adenoma. Conclusion: The diagnosis of Cushing’s syndrome during pregnancy has some difficulties. Fast weight gain, muscle atrophy of the extremities, concentric obesity and belly bruxism all suggest Cushing’s syndrome. 24-hour urinary free cortisol test is the best screening test. Retroperitoneal laparoscopic surgery is safe and effective, the recommended timing of surgery for the second trimester.