title: Hyperreactio luteinalis could be a risk factor for development of HELLP syndrome: case report.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital for Tumors, Zagreb, Croatia. ozren.grgic@gmail.hr
authors.forename: Ozren
authors.initials: O
authors.lastname: Grgic
authors.forename: Branko
authors.initials: B
authors.lastname: Radakovic
authors.forename: Dubravko
authors.initials: D
authors.lastname: Barisic
mesh_terms: 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
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human