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Intractable hyperemesis gravidarum, transient hyperthyroidism and intrauterine growth restriction associated with
Robert B Gherman1, Jorge H Mestman, Andrew J Satin
1Division of Maternal/Fetal Medicine, Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, National Naval Medical Center, Bethesda Naval Hospital, Bethesda, Maryland, USA. ghermtoo@aol.com
Background:
Hyperreactio luteinalis represents benign pregnancy-associated ovarian enlargement caused by multiple theca-lutein cysts. It is usually discovered incidentally at the time of ultrasound, cesarean section or postpartum tubal ligation with the majority of cases asymptomatic.
Case:
A 30-year-old, nulliparous, West African woman initially presented with hyperemesis gravidarum at 8 weeks' gestation. Bilateral, 10-cm theca-lutein cysts were discovered on ultrasound at 27 weeks. Despite intravenous hyperalimentation, the patient continued to have intractable vomiting and transient episodes of hyperthyroidism. She delivered a 1,450-g, female infant at 33 weeks; findings at the time of cesarean delivery included bilateral 10 x 8-cm theca-lutein cysts. Laboratory evaluation confirmed clinical evidence of virilization, with markedly elevated levels of testosterone and androstenedione.
Conclusion:
Intractable hyperemesis gravidarum, transient hyperthyroidism and intrauterine growth restriction may be associated with hyperreactio luteinalis.