Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
Department of Pediatric and Adolescent Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
J Pediatr Adolesc Gynecol. 2020 Dec;33(6):723-726. doi: 10.1016/j.jpag.2020.09.002. Epub 2020 Sep 22.
Ovarian torsion can occur in Van Wyk Grumbach syndrome, a disorder characterized by severe primary hypothyroidism and ovarian enlargement. To date, all documented cases of torsion in this setting describe oophorectomy, which has significant hormonal and fertility implications.
A 9-year-old pubertal girl presented to the emergency room with abdominal pain. Magnetic resonance imaging demonstrated bilateral, multi-cystic ovaries. Operative laparoscopy confirmed unilateral adnexal torsion, and detorsion without oophorectomy was accomplished. Postoperative laboratory tests revealed severe primary hypothyroidism. Ovarian size was reduced with hormone replacement therapy.
This case demonstrates that prompt interdisciplinary intervention and awareness of severe hypothyroidism as a cause of ovarian torsion related to enlarged, multi-cystic ovaries may reduce the rate of oophorectomy, allowing preservation of pediatric patients' future fertility, and reducing morbidity postoperatively through prompt, long-term thyroid supplementation.
卵巢扭转可能发生在范维克-格鲁姆巴赫综合征中，这是一种以严重原发性甲状腺功能减退症和卵巢增大为特征的疾病。迄今为止，该疾病中所有记录的扭转病例均描述了卵巢切除术，这对激素和生育能力有重大影响。
一名 9 岁青春期女孩因腹痛到急诊室就诊。磁共振成像显示双侧多囊卵巢。手术腹腔镜检查证实为单侧附件扭转，并成功进行了复位而未切除卵巢。术后实验室检查显示严重原发性甲状腺功能减退症。卵巢大小通过激素替代疗法缩小。
本病例表明，及时的多学科干预和对严重甲状腺功能减退症作为与增大的多囊卵巢相关的卵巢扭转的原因的认识，可能会降低卵巢切除术的发生率，从而保留儿科患者未来的生育能力，并通过及时的长期甲状腺素补充减少术后发病率。
