Spontaneous ovarian hyperstimulation syndrome and pituitary adenoma: incidental pregnancy triggers a catastrophic event.
OBJECTIVE
To report a rare case of spontaneous ovarian hyperstimulation syndrome (OHSS) associated with spontaneous pregnancy and a FSH-secreting pituitary adenoma.


METHODS
Case report.


METHODS
University hospital.


METHODS
A 32-year-old woman with spontaneous OHSS.


METHODS
Transsphenoidal resection of the tumor.


METHODS
Regression of the symptoms of OHSS and hyperestrogenemia.


RESULTS
At presentation, the patient's ovaries were markedly enlarged and massive ascites was seen. Her serum E(2) level was markedly elevated, but her LH level was low, and FSH was within the normal range. In addition, her TSH level was normal, and hCG was appropriate for the date of pregnancy. Subsequently, the patient developed massive thrombophlebitis in her right internal jugular and subclavian veins. Termination of the pregnancy ameliorated the accumulation of ascites, but ovarian enlargement and hyperestrogenemia persisted. No mutations of the FSH receptor, LH receptor, or aromatase genes were detected, but magnetic resonance imaging (MRI) of the head revealed a pituitary adenoma. After transsphenoidal resection of the tumor, the patient got better.


CONCLUSIONS
A gonadotropin-secreting adenoma caused ovarian hyperstimulation (ovarian enlargement and hyperestrogenemia). In addition, spontaneous pregnancy and intrinsic hCG increased vascular permeability, which complicated the patient's disease.
Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Hokkaido, Japan. tbaba@sapmed.ac.jp
Tsuyoshi
T
Baba
Toshiaki
T
Endo
Yoshimitsu
Y
Kitajima
Hirofumi
H
Kamiya
Osamu
O
Moriwaka
Tsuyoshi
T
Saito
D000236:Adenoma / Q000150:complications* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D004107:Dilatation and Curettage; D004967:Estrogens / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000378:metabolism; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000150:complications* / Q000628:therapy; D019152:Paracentesis; D010911:Pituitary Neoplasms / Q000150:complications* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy; D016216:Ultrasonography, Prenatal / Q000009:adverse effects
D000925:Anticoagulants; D004967:Estrogens; D005640:Follicle Stimulating Hormone