Intractable hyperemesis gravidarum, transient hyperthyroidism and intrauterine growth restriction associated with hyperreactio luteinalis. A case report.
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.


METHODS
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.


CONCLUSIONS
Intractable hyperemesis gravidarum, transient hyperthyroidism and intrauterine growth restriction may be associated with hyperreactio luteinalis.
Gherman
Robert B
RB
Division 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
Mestman
Jorge H
JH
Satin
Andrew J
AJ
Goodwin
T Murphy
TM
D000328:Adult; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology*; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000209:etiology*; D006980:Hyperthyroidism / Q000209:etiology*; D007231:Infant, Newborn; D008184:Luteal Cells; D010048:Ovarian Cysts / Q000150:complications*; D016471:Ovarian Hyperstimulation Syndrome / Q000150:complications; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D013997:Time Factors; D016216:Ultrasonography, Prenatal