王含必，平凡，刘美芝，邓成艳

(中国医学科学院　北京协和医学院　北京协和医院妇产科，北京　100730)



非典型先天性肾上腺皮质增生症误诊为多囊卵巢综合征二例报告

王含必，平凡，刘美芝，邓成艳*

(中国医学科学院北京协和医学院北京协和医院妇产科，北京100730)

目的总结分析避孕药引起高孕酮血症患者的临床特征，探讨其诊治要点、鉴别诊断及治疗。方法两例患者因月经紊乱及不育而就诊，误诊为多囊卵巢综合征。口服避孕药治疗后孕酮值异常升高，以此为线索最终确诊为非典型先天性肾上腺皮质增生症。结果明确诊断后进行强的松类药物治疗，一例有3次试管婴儿治疗失败史的患者，治疗控制病情后一次试管婴儿即成功。另一例经强的松治疗后疗效明显，月经恢复正常。结论非典型先天性肾上腺皮质增生误诊为多囊卵巢综合征二例报告，提示早卵泡期血清孕酮水平的升高可作为诊断线索，口服避孕药使孕酮水平升高的案例非常罕见，发生这种情况必须进一步进行排除诊断。

孕酮；非典型先天性肾上腺皮质增生症；多囊卵巢综合症；口服避孕药

Methods：Two patients were treated in gynecological clinics for menstrual disorders and infertility. According to the symptom and physical signs，polycystic ovary syndrome (PCOS) was diagnosed firstly. The progesterone levels were increased significantly after administration of oral contraceptive. Based on deeper investigation of the clues，the terminal diagnosis was non-classic congenital adrenal cortex hyperplasia (NCCAH).

Results：The prednisone was used in the two patients after positive diagnosis. One patient had received IVF-ET therapy for three times in another hospital and failed. After the standard treatment for the NCCAH，the woman got pregnancy through one cycle of IVF-ET treatment. The another patient got the regular menstrual.

Conclusions：NCCAH was easily misdiagnosed as PCOS. The elevation of progesterone level during the early follicular phase could be used as a clue for the diagnosis. The progesterone level being significantly higher after administration of oral contraceptive was rare. In this case，further evaluation to exclude the other diseases should be carried out.

(JReprodMed2016，25(10)：932-936)

临床中引起高孕酮血症的疾病最常见于非典型先天性肾上腺皮质增生症(nonclassic congenital adrenal hyperplasia，NCCAH)，由于这类疾病的女性患者常常伴发月经紊乱而到妇产科首诊。如果基础性激素水平中孕酮水平高于生育年龄女性排卵后孕酮值(≥9.54 nmol/L)，通常会引起妇产科医生的重视，很快会转入内分泌科就诊。但有时孕酮水平仅轻度升高，如(3.18～6.36)nmol/L左右，常常易被忽略。……