Intractable hyperemesis gravidarum, transient hyperthyroidism and intrauterine growth restriction associated with hyperreactio luteinalis: A case report

BACKGROUND: Hyperreactio luteinalis represents benign pregnancy-associated ovarian enlargement caused by multiple theca-lutein cysts. It is usually discovered incidentally at the time of ultrasound, cesarean section or postpartum tubal ligation with the majority of cases asymptomatic. CASE: A 30-year-old, nulliparous, West African woman initially presented with hyperemesis gravidarum at 8 weeks' gestation. Bilateral, 10-cm theca-lutein cysts were discovered on ultrasound at 27 weeks. Despite intravenous hyperalimentation, the patient continued to have intractable vomiting and transient episodes of hyperthyroidism. She delivered a 1,450-g, female infant at 33 weeks; findings at the time of cesarean delivery included bilateral 10x8-cm theca-lutein cysts. Laboratory evaluation confirmed clinical evidence of virilization, with markedly elevated levels of testosterone and androstenedione. CONCLUSION: Intractable hyperemesis gravidarum, transient hyperthyroidism and intrauterine growth restriction may be associated with hyperreactio luteinalis.