Incidentally found hyperreactio luteinalis in pregnancy

Abstract

Hyperreactio luteinalis (HL) is a rare pregnancy-related condition in which the ovaries become massively enlarged bilaterally, occupied by multiple benign theca lutein cysts, secondary to increased ovarian stimulation by beta-human chorionic gonadotropin (B-hCG). HL should resolve spontaneously postpartum, however, their occurrence has led some physicians unfamiliar with the natural history of the condition to perform unnecessary ovarian cystectomies or oophorectomies. A healthy 32-year-old woman was incidentally found to have new onset multicystic ovaries on ultrasound at 31 + 3 weeks gestational age, which continued to enlarge, with a maximum volume of ∼448.0 cm³ and ∼323.5 cm³ in right and left ovaries, respectively. She also developed signs and symptoms of hyperandrogenism, and later abdominal pain which ultimately expedited delivery. This paper demonstrates that familiarity with HL as a clinical entity, its typical presentation and natural history, and targeting conservative management is paramount in minimizing iatrogenic harm by obstetricians given the increased use of ultrasound in pregnancy. Patients presenting after the first trimester with bilateral multicystic ovaries with a "spoke wheel" appearance on ultrasound, hyperandrogenism, abnormally elevated B-hCG, or symptoms consistent with elevated B-hCG should prompt a possible diagnosis.

Keywords: Adnexal mass in pregnancy; Elevated B-hCG; Hyperandrogenism in pregnancy; Hyperreactio luteinalis; Multicystic ovaries in pregnancy; Theca lutein cysts.

Fig. 1

Ultrasound of right ovary at 31 + 3 weeks. Simple appearing cysts, thin septations, and no solid components

Fig. 2

Ultrasound of right ovary at 31 + 3 weeks. Simple appearing cysts, thin septations, and no solid components

Fig. 3

Multicystic ovaries at time of cesarean section

Fig. 4

Multicystic ovaries at time of cesarean section