Hyperreactio luteinalis: timely diagnosis minimizes the risk of oophorectomy and alerts clinicians to the associated risk of placental insufficiency

Hyperreactio luteinalis encountered during caesarean delivery of an uncomplicated spontaneous singleton pregnancy

“…Hyperreactio luteinalis is thought to be an exaggerated ovarian luteinisation due to increased levels of circulating hCG or to abnormal ovarian response to hCG 1 2. Hyperreactio luteinalis has been described as complicating pregnancies with elevated placental hCG (multiple pregnancies, gestational trophoblastic disease)6 7 and decreased clearance of hCG due to renal dysfunction8; but it has also been observed in normal singleton pregnancies,4–6 as occurred in the present case, with levels of hCG not abnormally elevated.…”

“…Clinical symptoms include maternal abdominal pain or acute abdomen due to ovarian torsion or haemorrhage 1 2. Virilisation is seen in 15–25%4 10 of patients, but hyperandrogenaemia is more frequent 4.…”

“…Besides, hormonal changes in hyperreactio luteinalis may contribute to alterations in coagulation factors and predispose the patient to thromboembolic complications 14. These factors explain the association that has been made between hyperreactio luteinalis and some pregnancy complications such as preeclampsia, hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome, severe fetal growth restriction and preterm delivery 2 10 13 15. In this case, the hCG level was not abnormally elevated and no such complications occurred.…”

“…The exact aetiology of hyperreactio luteinalis is unknown, but there is some evidence of genetic predisposition and a possibility for recurrence in future pregnancies 2. This entity is characterised by bilateral ovarian enlargement due to theca-lutein cysts and excessive production of ovarian androgens during pregnancy, with spontaneous regression after delivery 3.…”

“…Many patients have no symptoms or pregnancy complications 3. However, the enlarged ovaries may cause abdominal pain or acute abdomen due to ovarian torsion or haemorrhage, and pregnancy may be complicated by placental or hypertensive disorders 2 3…”