4例口服复方避孕药致假性库欣综合征病例分析

Analysis on four cases of oral contraceptive pills induced pseudo-Cushing’s syndrome

摘要:

目的：研究我院收治的4例口服复方避孕药（oral contraceptive pills，OCPs）后致假性库欣综合征病例的临床特征以及复习OCPs影响皮质醇测定的相关文献。方法：回顾性分析4例因月经稀发服用OCPs的育龄期女性患者的临床特点。应用等倍稀释的方法测定OCPs与血总皮质醇之间的交叉反应，并复习相关文献。结果：4例患者在服用OCPs期间均发现血总皮质醇的升高。3例患者均在停用OCPs之后血总皮质醇降至正常。予等倍稀释的方法，在OCPs溶液中测定血总皮质醇，交叉反应小。文献中报道OCPs可能从以下两方面导致假性库欣综合征：OCPs中的雌激素增加皮质醇结合球蛋白的合成而引起血总皮质醇的升高；OCPs可能通过直接刺激下丘脑-垂体-肾上腺轴使血总皮质醇生成增多。结论：OCPs可通过多种机制导致假性库欣综合征，临床上需结合患者的临床表现、体格检查以及其他的实验室结果与库欣综合征进行鉴别，以免误诊、误治。

Abstract:

Objective：To study clinical features of four cases of oral contraceptive pills（OCPs） induced pseudo-Cushing’s syndrome and to review the literature related to cortisol assay affected by OCPs. Methods：The clinical features of the four childbearing age fe－male patients，who have taken OCPs due to oligomenorrhea，were analyzed retrospectively. The cross-reactivity between OCPs and serum total cortisol were analyzed retrospectively. Results：Elevated serum total cortisol was found in four patients while taking OCPs. Serum total cortisol of three patients returned to be normal after OCPs discontinuance. Based on the results of equal dilution，the cross-reactivity of serum total cortisol in OCPs was insignificant. OCPs may affect serum total cortisol in two ways as reported in the litera－ture：estrogen increases cortisol-binding globulin，causing elevated serum total cortisol；OCPs may directly stimulate the hypothalamic-pituitary-adrenal axis to generate cortisol. Conclusion：OCPs may result in pseudo-Cushing’s syndrome by a variety of mechanisms. Clinicians should pay attention to this issue to avoid misdiagnosis and mistreatment.