title: Massive ascites and hydrothorax after leuprolide acetate administration in a down-regulated woman undergoing assisted reproduction.
abstract: 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.
authors: Centre for Reproductive Medicine, Department of Obstetrics, Gynaecology, and Neonatology, University of Parma, Parma, Italy. bruno.ferrari@unipr.it
authors: Bruno
authors: B
authors: Ferrari
authors: Antonio
authors: A
authors: Pezzuto
authors: Francesco
authors: F
authors: Coppola
mesh_terms: 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*
chemical_list: D005665:Furosemide; D016729:Leuprolide