Initial presentation of undiagnosed acute intermittent porphyria as a rare complication of ovulation induction.
OBJECTIVE
To discuss the diagnosis and management of acute intermittent porphyria following ovulation induction.


METHODS
Case report.


METHODS
Academic IVF center.


METHODS
A patient with polycystic ovary syndrome and primary infertility undergoing ovulation induction with clomiphene citrate.


METHODS
Serial phlebotomy, IV fluid, inpatient observation.


METHODS
Condition at discharge.


RESULTS
The patient was diagnosed with severe hyponatremia caused by acute volume depletion and possible syndrome of inappropriate antidiuretic hormone secretion, secondary to acute intermittent prophyria, and was successfully managed with supportive measures. Neurovisceral symptoms resolved, and severe hyponatremia was corrected with IV saline solution without complications.


CONCLUSIONS
Acute intermittent porphyrias are rare complications of ovulation induction, but should be considered in patients who develop unexplained hyponatremia or neurovisceral symptoms.
Wang
Jeff G
JG
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Columbia University, New York, New York 10023, USA. jw781@columbia.edu
Guarnaccia
Michael
M
Weiss
Stacey F
SF
Sauer
Mark V
MV
Choi
Janet M
JM
D000328:Adult; D002996:Clomiphene / Q000009:adverse effects*; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects*; D006801:Humans; D007010:Hyponatremia / Q000209:etiology*; D007177:Inappropriate ADH Syndrome / Q000209:etiology*; D007247:Infertility, Female / Q000628:therapy; D010062:Ovulation Induction / Q000009:adverse effects*; D017118:Porphyria, Acute Intermittent / Q000139:chemically induced* / Q000150:complications
D005300:Fertility Agents, Female; D002996:Clomiphene