Chauhan Yash V, Dalwadi Pradip P, Gada Jugal V, Varthakavi Premlata K, Bhagwat Nikhil
Endocrinology, Topiwala National Medical College & Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, IND.
Cureus. 2021 Feb 26;13(2):e13573. doi: 10.7759/cureus.13573.
Hyperreactio luteinalis (HRL) is characterised by benign enlargement of ovaries in pregnancy associated with hyperandrogenism. A 19-year-old primigravida presented with breathlessness, abdominal distension and vomiting in the thirteenth week of gestation. Abdominal examination revealed distension of abdomen disproportionate to the gestational age. Ultrasound was suggestive of bilaterally enlarged multicystic ovaries with a characteristic "spoke-wheel" pattern and a diagnosis of HRL was made. Laboratory investigations revealed primary hypothyroidism and elevated testosterone. She was initiated on levothyroxine therapy. Her respiratory distress worsened on the third day of admission for which she underwent emergency laparotomy with cyst aspiration. Thyroid function tests normalized within six weeks after the initiation of therapy and remained normal for the remainder of pregnancy. Serum testosterone levels returned to normal six weeks postpartum. The elevated thyroid-stimulating hormone levels could have contributed to development of HRL by cross-reacting with human chorionic gonadotropin and follicle-stimulating hormone receptors. Hyperandrogenism and ovarian enlargement regresses with levothyroxine therapy.
黄素化囊肿过度反应（HRL）的特征是孕期卵巢良性增大并伴有高雄激素血症。一名19岁初产妇在妊娠第13周时出现呼吸困难、腹胀和呕吐。腹部检查发现腹部膨隆与孕周不符。超声检查提示双侧多囊卵巢增大，呈特征性的“辐条轮”模式，诊断为HRL。实验室检查发现原发性甲状腺功能减退和睾酮升高。她开始接受左甲状腺素治疗。入院第三天，她的呼吸窘迫加重，为此接受了急诊剖腹手术并进行囊肿抽吸。治疗开始后六周内甲状腺功能测试恢复正常，且在妊娠剩余时间内保持正常。产后六周血清睾酮水平恢复正常。甲状腺刺激激素水平升高可能通过与人绒毛膜促性腺激素和促卵泡激素受体交叉反应而导致HRL的发生。左甲状腺素治疗后高雄激素血症和卵巢增大消退。
