Obstetric Clinical Analysis in 8 Cases With Cushing’s Syndrome

CAI Shi-qin; ZHU Cai-xia; ZHANG Zhe-chao; ZHANG Ying; CHEN Hai-tian

doi:10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0314

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Obstetric Clinical Analysis in 8 Cases With Cushing’s Syndrome

Clinical Research | 更新时间：2024-02-19

- Obstetric Clinical Analysis in 8 Cases With Cushing’s Syndrome
- Journal of Sun Yat-sen University(Medical Sciences) Vol. 44, Issue 3, Pages: 471-478(2023)
- 作者机构：
  
  中山大学附属第一医院妇产科，广东广州 510080
- 作者简介：
  
  CHEN Hai-tian；E-mail：chhait@mail.sysu.edu.cn
- 基金信息：
- DOI：10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0314
  CLC： R71
- Received：21 October 2022，
  
  Published：20 May 2023
- 稿件说明：
移动端阅览
蔡诗琴,祝彩霞,张喆超等.妊娠合并库欣综合征8例的临床分析[J].中山大学学报（医学科学版）,2023,44(03):471-478.

CAI Shi-qin,ZHU Cai-xia,ZHANG Zhe-chao,et al.Obstetric Clinical Analysis in 8 Cases With Cushing’s Syndrome[J].Journal of Sun Yat-sen University(Medical Sciences),2023,44(03):471-478.
蔡诗琴,祝彩霞,张喆超等.妊娠合并库欣综合征8例的临床分析[J].中山大学学报（医学科学版）,2023,44(03):471-478. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0314.

CAI Shi-qin,ZHU Cai-xia,ZHANG Zhe-chao,et al.Obstetric Clinical Analysis in 8 Cases With Cushing’s Syndrome[J].Journal of Sun Yat-sen University(Medical Sciences),2023,44(03):471-478. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0314.

摘要

目的

总结分析妊娠合并库欣综合征患者的临床特点、诊疗经过和母儿预后，优化其妊娠期管理。

方法

回顾性收集2006年1月至2022年8月在中山大学附属第一医院住院治疗的8例妊娠合并库欣综合征患者的临床资料并随访新生儿结局，总结其临床特征、治疗方法及妊娠结局。

结果

8例患者中，并发子痫前期4例，孕前糖尿病2例，妊娠期糖尿病5例，低钾血症8例。实验室检查均发现血清皮质醇升高、昼夜节律消失，24 h尿皮质醇升高，血促肾上腺皮质激素下降；影像学检查肾上腺彩超或MR检查提示肾上腺肿瘤。8例孕妇中3例选择于妊娠中期行腹腔镜手术，4例选择保守治疗，产后行腹腔镜手术，术后病理均提示肾上腺皮质腺瘤。8例患者中自然流产1例，足月产1例和早产6例，7例活产中顺产1例，剖宫产6例。7例新生儿中低出生体重儿3例；新生儿多发畸形1例，新生儿左侧重复肾1例，转儿科4例，死亡2例，随访中发现1例幼儿在2岁时确诊为肾病综合征。

结论

妊娠合并库欣综合征罕见且高危，需要多学科团队进行确诊、管理和长期随访。

Abstract

Objective

To summarize and analyze the clinical characteristics， diagnosis process， treatment process， and obstetric outcomes of pregnant women with Cushing's syndrome， helping to optimize pregnancy management.

Methods

A retrospective study was conducted on 8 pregnant women with Cushing’s syndrome who were hospitalized in the First Affiliated Hospital， Sun Yat-sen University between January 2006 and August 2022. The clinical characteristics， management and obstetric outcomes were recorded.

Results

Preeclampsia was detected in 4 cases，pre-gestational diabetes mellitus in 2 cases， gestational diabetes mellitus in 5 cases， and hypokalemia in all 8 cases. Elevated serum cortisol， disappearance of day-night rhythm of cortisol， increased 24-hour urine cortisol and decrease in serum ACTH were found in 8 cases by laboratory examination. Furthermore， adrenal adenoma was detected in all 8 cases by ultrasonography or Magnetic Resonance Imaging. Three cases underwent laparoscopic adrenalectomy in the second trimester and 4 cases received surgery after delivery. The diagnosis of adrenal cortical adenoma was confirmed by pathological report. Six cases had preterm birth， while one patient delivered after 37 weeks of gestation and one patient suffered from spontaneous abortion. Among 7 cases of live birth， 6 patients underwent cesarean section and 1 patient had vaginal delivery. Of all newborns， 3 had low birth weight. One case had a birth defect. Four infants were transferred to the neonatal intensive care unit， and two infants died. One child was diagnosed with nephrotic syndrome at 2 years of age.

Conclusions

Cushing's syndrome is rare and high risk during pregnancy. It requires multidisciplinary diagnosis， treatment， and long-term follow-up. Drug therapy carries a risk of progression and requires intensive care during pregnancy， postpartum follow-up， and specialist treatment.

关键词

Keywords

references

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