Bilateral oophorectomy in a pregnant woman: hormonal profile from late gestation to post-partum: case report.
BACKGROUND
A 16 week pregnant woman presented with massive theca-lutein cysts requiring bilateral oophorectomy. Pregnancy progressed uneventfully and spontaneous lactation ensued after delivery.


METHODS
To study the role of the ovary on the hormonal profile at the end of gestation and in post-partum, we measured FSH, estradiol (E2), unconjugated estrone (E1), unconjugated estriol (E3), sex hormone-binding globulin, progesterone, dehydroepiandrosterone sulphate and prolactin at 37 weeks gestation and at 8 h, 4 days, 5 weeks, and 2 months post-partum.


RESULTS
These hormones were within the range expected for ovary-intact pregnant and puerperal women until 4 days post-partum. At 5 weeks post-partum, FSH increased to a peri-menopausal range (31.4 IU/l) while estrogens remained within the normal puerperal range (E2=239 pmol/l; E1=102 pmol/l), contrasting with their rapid changes in non-pregnant women after bilateral oophorectomy. At 2 months, while partially breastfeeding, FSH, E2 and E1 were closer to menopausal range (68 IU/l, 136 and 70.2 pmol/l respectively), and hormone replacement was started.


CONCLUSIONS
We conclude that the ovary is not required to maintain a normal hormonal profile in late pregnancy and early puerperium. However, the increase in FSH to peri-menopausal levels at 5 weeks post-partum, despite breastfeeding, suggests that the ovary is needed to maintain low FSH concentrations during lactation.
Villaseca
Paulina
P
Department of Endocrinología, Facultad de Medicina, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile. pvillase@med.puc.cl
Campino
Carmen
C
Oestreicher
Eveline
E
Mayerson
David
D
Serón-Ferré
María
M
Arteaga
Eugenio
E
D000328:Adult; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D004958:Estradiol / Q000097:blood; D004964:Estriol / Q000097:blood; D004970:Estrone / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D012739:Gonadal Steroid Hormones / Q000097:blood*; D006801:Humans; D007774:Lactation / Q000097:blood; D010048:Ovarian Cysts / Q000097:blood / Q000601:surgery*; D010052:Ovariectomy; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000601:surgery*; D011263:Pregnancy Trimester, Third / Q000097:blood; D011374:Progesterone / Q000097:blood; D011388:Prolactin / Q000097:blood; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism
D012739:Gonadal Steroid Hormones; D012738:Sex Hormone-Binding Globulin; D004970:Estrone; D011374:Progesterone; D004958:Estradiol; D019314:Dehydroepiandrosterone Sulfate; D011388:Prolactin; D005640:Follicle Stimulating Hormone; D004964:Estriol