Spontaneous long-term remission in a patient with premature ovarian failure

Abstract

Objective: To describe a patient with premature ovarian failure who after a pregnancy achieved a prolonged remission, which has lasted for more than 10 years.

Methods: Clinical and laboratory data of a patient who had premature ovarian failure with a spontaneous pregnancy and a prolonged remission are described. The pertinent literature is reviewed and summarized.

Results: A 26-year-old woman presented with secondary amenorrhea of 6 months' duration in 1984. Her serum total estrogen level was low, and gonadotropins were in the postmenopausal range. She also had a history of primary hypothyroidism, diagnosed in 1979. The physical examination showed normal findings, except for an enlarged thyroid gland and a few areas of vitiligo on her back, arms, and legs. Antithyroid antibodies were present. Adrenal insufficiency was excluded on the basis of results of the cosyntropin stimulation test. She had a normal 46,XX karyotype. A diagnosis of premature ovarian failure was made, and therapy with cyclic estrogen and progesterone was initiated. In 1991, she spontaneously conceived and gave birth to a healthy baby. After delivery, the patient began to have normal menstrual cycles and continues to do so without hormone replacement therapy. Subsequently, serum estrogen and gonadotropins were in the normal range. Her thyroid antibodies also became negative. When last contacted by her primary-care physician in November 2002, she was still having normal menstrual periods, and the patches of vitiligo were no longer present.

Conclusion: It is well known that many autoimmune diseases subside during pregnancy; however, most of them relapse in the postpartum period. The mechanism of the prolonged remission in our patient is unknown, but hormonal as well as autoimmune changes related to pregnancy and the post partum period might have had a role.