Incidental Finding Of Hyperreactio Luteinalis during Caesarean Section in Twin Pregnancy

Abstract

BACKGROUND:Some benign changes of the ovaries like hyper reaction luteinalis sometimes cannot be differentiated from malignant ones without histological examination. In these cases, surgical intervention sometimes cannot be avoided. Hyperreactio luteinalis is a condition that can occur only in pregnancy. It is characterised by bilateral benign multicystic ovarian enlargement.CASE REPORT:We present a case of misleading intraoperative findings during Cesarean section that ended with ovariectomy.CONCLUSION:During the Caesarean section, some benign masses of the ovaries, like hyper reaction luteinalis, are difficult to differentiate from malignant disease without histological examination, requiring surgical intervention.

Unrecognized Primary Hypothyroidism As a Possible Cause of Hyperreactio Luteinalis

“…The risk factors for HRL are multiple gestations, Rh sensitization, twin to twin transfusion syndrome, hydrops fetalis, gestational trophoblastic neoplasia, molar pregnancy, choriocarcinoma, primary hypothyroidism, prior history of PCOS, gestational diabetes, ovulation induction with clomiphene and renal dysfunction (delaying the clearance of β-HCG) [ 13 ].…”

“…One particular variant lacking the C-terminal peptide of the β-subunit of the glycoprotein, almost identical to luteinizing hormone (LH), has been implicated to stimulate the ovary. The structural similarity between β-HCG, follicle-stimulating hormone (FSH), LH and TSH is responsible for the possible association of HRL with primary hypothyroidism, FSH-secreting adenoma, and PCOS [ 1 , 2 , 13 , 14 ]. Extremely elevated levels of TSH act via FSH receptors to cause follicular stimulation and via LH/β-HCG receptors to secrete testosterone from theca cells.…”

“…Occasionally, patients may present with compressive symptoms such as abdominal discomfort, dyspnoea and abdominal pain. Maternal virilization due to hyperandrogenism is present in around 30% patients, most commonly in those presenting in the third trimester [ 1 , 13 ]. Increased levels of sex-hormone binding globulin during pregnancy may be responsible for the reduced frequency of clinical manifestations of hyperandrogenism [ 16 ].…”

“…The possible complications include pre-eclampsia; hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome; intra-uterine growth retardation; premature labour; ovarian torsion; dystocia; delayed lactation and foetal reproductive defects [ 13 ]. β-HCG has been linked with many regulatory functions in pregnancy including cytotrophoblast differentiation, angiogenesis and foetal growth and organogenesis.…”

Touch-me-not: Hyperreactio luteinalis during caesarean delivery of a spontaneously conceived singleton term pregnancy with chronic hypertension: A case report

“…2 HL is a rare condition 3 which usually occurs in women with high β-hCG levels such as pregnancies with multifetal gestation, molar pregnancy and choriocarcinoma. 4 It is also seen in women with polycystic ovarian syndrome (PCOS) owing to the increased sensitivity of the ovarian stroma to β hCG. 4…”