Hyperreactio luteinalis could be a risk factor for development of HELLP syndrome: case report.
OBJECTIVE
To report a unique case of hyperreactio luteinalis in pregnancy associated with ovarian torsion and subsequent development of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome.


METHODS
Case report.


METHODS
University medical center.


METHODS
A 34-year-old primigravida woman with ovarian torsion in 13 weeks of pregnancy and subsequent intrauterine growth restriction (IUGR) and HELLP syndrome.


METHODS
Laparoscopic salpingo-oophorectomy due to the ovarian torsion and cesarean section (CS) due to the development of HELLP syndrome.


METHODS
HELLP syndrome.


RESULTS
In the first trimester the patient had symptoms of acute abdomen due to the ovarian torsion. Both ovaries were enlarged and multicystic. Hormonal studies confirmed an abnormally elevated level of hCG (192.000 IU/L), mild hyperthireosis, and hyperandrogenemia. Laparoscopic salpingo-oophorectomy was performed. At 30 weeks of pregnancy, IUGR was confirmed sonographically and clinically, and at 33 weeks severe preeclampsia developed. One week later, HELLP syndrome occurred. Emergency CS was preformed, and she delivered a female newborn weighing 1,640 g. Seven days after delivery, blood pressure and hormonal status returned to normal.


CONCLUSIONS
Hyperreactio luteinalis due to the abnormally high level of hCG in the first trimester could be a consequence of inappropriate trophoblast invasion and an early sign of subsequently developing preeclampsia, eclampsia, and HELLP syndrome.
Grgic
Ozren
O
Department of Obstetrics and Gynecology, University Hospital for Tumors, Zagreb, Croatia. ozren.grgic@gmail.hr
Radakovic
Branko
B
Barisic
Dubravko
D
D000328:Adult; D002585:Cesarean Section; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D004638:Emergency Treatment; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D017359:HELLP Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D010535:Laparoscopy; D050498:Live Birth; D010048:Ovarian Cysts / Q000150:complications* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery; D010049:Ovarian Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D010052:Ovariectomy; D011247:Pregnancy; D012307:Risk Factors; D014102:Torsion Abnormality / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D016216:Ultrasonography, Prenatal; D015854:Up-Regulation
D018997:Chorionic Gonadotropin, beta Subunit, Human