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First reported convergence of premature ovarian failure and cutis marmorata telangiectatica congenita
E Scott Sills1, Kallyn E Harmon, Michael J Tucker
1Georgia Reproductive Specialists LLC, Atlanta, Georgia 30342, USA. dr.sills@ivf.com
Objective:
To describe the convergence of five rare phenotypic features in a woman with premature ovarian failure referred for reproductive endocrinology evaluation.
Design:
Case report and literature review.
Setting:
Major urban infertility referral center.
Patient(S):
A 24-year-old nulligravida with cutis marmorata telangiectatica congenita (CMTC), premature ovarian failure, unilateral ovarian agenesis, septate uterus, and de novo balanced autosomal translocation.
Intervention(S):
High-resolution chromosomal evaluation, radiographic study of reproductive organs, and assessment of endogenous estrogen production.
Main Outcome Measure:
Patient counseling regarding future reproductive options (i.e., donor oocyte in vitro fertilization/embryo transfer), and satisfactory management of hypoestrogenism using oral contraceptives.
Result(S):
We identified a balanced reciprocal translocation 46,XX t(8;9)(q22.1;p24.1), and confirmed unilateral ovarian agenesis with midline intrauterine septum.
Conclusion(S):
Although genetic factors considered contributory to premature ovarian failure usually involve the X chromosome, in our patient a previously undescribed autosomal translocation was identified in association with CMTC, a rare vascular disorder. The fundamental role of follicular oxygenation in oocyte competence and subsequent ovarian function is discussed. From the clinical and laboratory findings evident in this unusual case, a developmental hypothesis connecting the vascular abnormalities of CMTC and premature ovarian failure is offered.
