Development of Virilization During Pregnancy

Friedman, Isaac S.; Mackles, Abraham; Daichman, Isidore

doi:10.1210/jcem-15-10-1281

Cited by 19 publications

(4 citation statements)

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“…The virilization disap-pcared or diminished after pregnancy. In 1 case [3] and in our case the signs of viriliza tion reappeared in the second pregnancy. Mi croscopically all cases showed similar charac teristics as described above.…”

Section: Commentsupporting

confidence: 56%

“…Since 1930, approximately 50 cases of vir ilization associated with pregnancy have been described [3,4,7,9,12,14,20], Most of these were caused by a unilateral or bilateral ovarian tumor, and only few cases were with certainty due to bilateral hyperthecosis. Friedman et al [3] described a patient who developed virilization in both her pregnan cies.…”

Section: Commentmentioning

confidence: 99%

“…Friedman et al [3] described a patient who developed virilization in both her pregnan cies. The markedly elevated 17-ketosteroid excretion spontaneously decreased post par tum and also virilization disappeared.…”

Section: Commentmentioning

confidence: 99%

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Virilization during Pregnancy due to Bilateral Hyperthecosis

Erkkola¹,

Seppälä²,

Klemi³

1985

Horm Res

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A case of recurrent maternal virilization associated with bilateral hyperthecosis of the ovary during two pregnancies is described. In the first pregnancy, serum testosterone increased to the level of 12.5 nmol/l and in the second pregnancy to 35 nmol/l and after delivery to 66 nmol/l. 5 months after the second birth the testosterone level was 2.7 nmol/l and virilization had spontaneously regressed. Puerperal stimulation tests with human menopausal or with human chorionic gonadotropin did not increase ovarian androgen production. Female babies were not virilized.

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Section: Commentsupporting

confidence: 56%

Section: Commentmentioning

confidence: 99%

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Virilization during Pregnancy due to Bilateral Hyperthecosis

Erkkola¹,

Seppälä²,

Klemi³

1985

Horm Res

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“…5 The remaining two women presented with an ovarian mass noted on caesarean section at both deliveries. 8,9 Two neonates were female 5,7 with no evidence of virilisation and all others were male. Cord blood androgen levels were not measured.…”

Section: Discussionmentioning

confidence: 99%

Severe maternal virilisation of benign aetiology in two successive pregnancies

Ogilvie¹,

Davidson

et al. 2005

BJOG

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a Case reportA 34 year old school principal developed virilising symptoms at 35 weeks of gestation in her second pregnancy. Her menses had been regular but mild hirsutism and acne had been present since age 20 years.Her first child had been conceived at age 29, one year after stopping contraception. Mild acne and hirsutism had been noted at 16 weeks of gestation, and became more severe at 30 weeks of gestation, temporally associated with dexamethasone therapy for threatened early labour. Ultrasound scanning at 36 weeks had shown two solid homogeneous masses in the abdomen. The left measured 106 mL and the right 157 mL. She was induced at 37 weeks of gestation following signs of eclampsia and delivered a phenotypically normal male child. Postpartum maternal examination revealed significant hirsutism (Ferriman-Gallwey score 34/48) and cystic acne involving the face, trunk, and upper arms. Pelvic computed tomography was unremarkable postpartum and androgenic hormone measurements were in the normal range: testosterone <1 nmol/L, DHEAS 2.2 Amol/L, androstenedione 3.4 nmol/L, 17-hydroxyprogesterone 0.7 nmol/L. A combined anti-androgen-oestrogen oral contraceptive was prescribed (ethinylestradiol 35 Ag/ cyproterone acetate 2 mg), but was subsequently discontinued. There was spontaneous return of menses and resolution of her acne and hirsutism over the next 12 months.She conceived her second pregnancy aged 34 years and reported acne, hirsutism, lowering of her voice, and significant weight gain from 12 weeks of gestation. She was shaving facial hair twice daily and teaching had been become an embarrassment. Examination revealed significant virilisation with a FG score of 33, clitoromegaly of 2 cm, grade 4 acne on face, chest and back, and a deep voice. Her facial appearance was masculine. She was referred to our unit at 35 weeks for management.Endocrine data from this pregnancy are presented in Table 1, confirming extreme hyperandrogenism. Ultrasound at 34 weeks demonstrated a male fetus and bilateral solid ovarian masses, size not able to be determined due to the presence of the pregnant uterus. A decision was made to proceed with the pregnancy until fetal viability was assured, given the presence of a male fetus and the expectation that the underlying pathology was likely to be benign. By 36 weeks of gestation, maternal symptoms were so marked, however, that labour was induced and she was delivered of a healthy male infant, confirmed to have an XY karyotype.Magnetic resonance imaging two weeks postpartum revealed ovarian enlargement (36 mL bilaterally) but no masses or cysts, and androgen levels normalised within two weeks of delivery. Following a brief period of lactation, a Mirena IUD was inserted and sequential cyproterone was administered in a dose of 100 mg for 10 days per month, with gradual amelioration of her acne and hirsutes in the six months post-delivery. Ultrasound of the pelvis at three months postpartum demonstrated ovaries of normal volume (8 mL bilaterally) with no morphological evidence of polycystic...

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