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Hyperreactio luteinalis in pregnancy and hyperandrogenism: a case report.

Laxmi V Baxi, Lisa C Grossman, Rosanna Abellar

The Journal of Reproductive Medicine

|October 22, 2014

Summary

Hyperreactio luteinalis during pregnancy causes theca lutein cysts (TLCs) and maternal androgenization. These symptoms resolve postpartum, preventing fetal virilization due to testosterone aromatization.

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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.