Diagnosis and treatment of pregnancy complicated with hypercortisolism?

summary

Hypercortisolism, also known as Cushing's syndrome, is the most common form of adrenocortical hyperfunction. This is because the adrenal cortex secretes too much cortisol, but it often secretes other corticosteroids at the same time. Pregnancy complicated with hypercortisolism is very rare. Most of the pregnancies end in abortion, premature delivery or stillbirth.

Diagnosis and treatment of pregnancy complicated with hypercortisolism?

50% - 70% of hypercortisolism is caused by adrenal hyperplasia, 20% - 30% by adrenal adenoma or carcinoma, and 10% - 20% by pituitary adenoma. Women are three times as many as men, and most of them are between 15 and 35 years old. Amenorrhea and anovulation are caused by adrenocortical hyperfunction; About 30% of the patients had amenorrhea in the early stage of the disease, and 50% - 70% of the patients had amenorrhea after the disease progressed, followed by reversible ovarian atrophy, follicular reduction at each stage, leading to infertility.

The clinical manifestation of hypercortisolism is due to excessive cortisol in the body, resulting in metabolic disorders of sugar, protein, fat and electrolyte, and dysfunction of various organs. The main clinical manifestations were full moon face, centripetal obesity, purple lines, acne, diabetes tendency, hypertension, osteoporosis, amenorrhea, fatigue and so on.

Pregnancy induced hypertension often occurs in the second trimester of pregnancy. At the same time, due to the anti insulin effect of corticosteroids, the blood sugar increases. Therefore, we should actively control pregnancy induced hypertension and treat diabetes. After active treatment, the pregnancy period can be prolonged and the chance of getting a live baby increased. Patients with adrenocortical hyperfunction caused by adrenal cortical tumor during pregnancy can be considered for operation after diagnosis. Bevan believes that surgery during pregnancy is safe and can significantly reduce the incidence of stillbirth and premature birth.

matters needing attention

Due to the metabolic changes of glucocorticoid and salt corticoid during pregnancy, the production of cortisol and aldosterone increases with the growth of pregnancy, so the diagnosis of cortisol in pregnancy is difficult. The typical cases of pregnant women with hypercortisolism were full moon face, abdominal and inner side of limbs purple lines, acne, weight gain and elevated blood glucose; The levels of 17 hydroxycorticosteroids (17-OHCS) and free cortisol in 24 hours urine were significantly increased; B-mode ultrasonography of adrenal gland and perirenal aerography are helpful for the diagnosis.