Hyperreactio luteinalis in pregnancy and hyperandrogenism: a case report

Area of Science:

• Reproductive endocrinology
• Maternal-fetal medicine
• Gynecologic pathology

Background:

• Hyperreactio luteinalis is a rare ovarian hyperstimulation associated with pregnancy.
• It presents with bilateral theca lutein cysts (TLCs) and can cause maternal androgenization.

Observation:

• A case of a 24-year-old primigravid woman at 35 weeks gestation with bilateral enlarged cystic ovaries and signs of androgenization.
• Ovarian ultrasonography revealed a characteristic spoke-wheel appearance.
• Delivery via C-section was necessitated by an impacted ovarian cyst obstructing the birth canal.

Findings:

• Theca lutein cysts (TLCs) and maternal androgenization persisted into the postpartum period.
• Delayed lactogenesis resolved by 6 weeks postpartum following TLC regression.
• Maternal testosterone levels normalized by 3 months postpartum, with resolution of androgenization signs.

Implications:

• Aromatization of testosterone within hyperreactio luteinalis protects the fetus from virilization, distinguishing it from masculinizing ovarian tumors.
• Potential genetic predisposition and recurrence risk in future pregnancies warrant consideration.
• Understanding this condition is crucial for managing pregnancy complications and ensuring favorable maternal and fetal outcomes.