Massive ascites and hydrothorax after leuprolide acetate administration in a down-regulated woman undergoing assisted reproduction.
OBJECTIVE
To present an atypical case of massive ascites and hydrothorax after leuprolide acetate administration in a down-regulated woman undergoing assisted reproduction.


METHODS
Case report.


METHODS
Centre for Reproductive Medicine, Department of Obstetrics, Gynaecology, and Neonatology, University of Parma, Parma, Italy.


METHODS
A 41-year-old, nulliparous, white woman who developed massive ascites and hydrothorax after administration of 0.50 mg/day of subcutaneous leuprolide acetate, beginning at the midluteal phase.


METHODS
Down-regulation with the gonadotropin-releasing hormone analogue was discontinued, and therapy was started with furosemide 50 mg/day for 10 days.


METHODS
Successful medical reduction of ascites and hydrothorax.


RESULTS
Resolution of symptoms.


CONCLUSIONS
A comprehensive MEDLINE search revealed this to be the first reported case of massive ascites and hydrothorax after leuprolide acetate administration (0.5 mg daily) in a down-regulated woman undergoing assisted reproduction. This case can be explained by an increase in capillary permeability, which resulted in a rapid fluid shift from the intravascular space into the third space. We believe that ascites in our patient resulted from an increase in estradiol in the ovaries, due to a direct action of the gonadotropin-releasing hormone analogue on the corresponding ovarian receptors in the first few days after the start of therapy.
Ferrari
Bruno
B
Centre for Reproductive Medicine, Department of Obstetrics, Gynaecology, and Neonatology, University of Parma, Parma, Italy. bruno.ferrari@unipr.it
Pezzuto
Antonio
A
Coppola
Francesco
F
D000328:Adult; D001201:Ascites / Q000139:chemically induced* / Q000188:drug therapy; D015536:Down-Regulation; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D006876:Hydrothorax / Q000139:chemically induced* / Q000188:drug therapy; D007247:Infertility, Female / Q000188:drug therapy; D016729:Leuprolide / Q000009:adverse effects*; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*
D005665:Furosemide; D016729:Leuprolide