engleski

Hyperreactio luteinalis in twin pregnancy with unexpected adverse pregnancy outcome.

Case report describes pregnancy management and outcome of bichorionic biamniotic (BCBA) twin pregnancy with Hyperreactio luteinalis (HL) and accompanying severe hyperandrogenemia in women carrying female fetuses. HL with hyperandrogenism is rare condition, which may cause virilization of the mother and female fetus. According to limited data from current literature adverse pregnancy outcomes in these women are observed in 26% of cases. They are usually associated with preeclampsia, gestational diabetes and preterm delivery. The risk to the fetus depends on the timing and severity of the excess maternal androgen production. 35-year-old primigravida with twin pregnancy following frozen embryo transfer in natural cycle presented in 16th week of pregnancy with bilateral enlarged ovarian masses The hormone panel showed extremely elevated serum total testosterone (TT) 27.3 nmol/L, free testosterone (FT) 62.2 pmol/L, androstenedione (A) > 35 nmol/L levels. MRI of abdomen and pelvis ruled out androgen secreting tumor. The HL was diagnosed. Feto- placental unit and hormones were monitored every 3 weeks. Hyperandrogenemia was progressive and in 33rd week discordant twin growth was observed accompanied with hypertension. Respiratory distress syndrome prophylaxis was preformed and methyldopa was introduced. In 34th week absent umbilical artery end-diastolic flow was detected in one twin. Within 24 hours affected twin heartbeats were negative after two reassuring CTGs. Cesarean section was immediately performed. No signs of virilization of twins were observed. Umbilical cord serum androgen concentrations have been measured in twins. Stillborn twin had significantly higher androgen levels compared to liveborn twin (TT 5.5 vs. 2.2 nmol/L, fT 131.5 vs. 51.0 pmol/L, A 33.1 vs. 8.5 nmol/L). Pathological report was unremarkable. The mother’s androgen panel on the third postpartal day was still extreme (TT 39.4 nmol/L, fT 92.5 pmol/L, A 250 nmol/L). A control hormonal panel two weeks later normalized. Hyperandrogenism in pregnancy complicated with fetal brain-sparing effect could lead to accelerated exhaustion of fetal compensatory mechanisms. Therefore, in such situation prompt delivery may be a reasonable option.

hyperreactio luteinalis, pregnancy

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