Hyperreactio luteinalis in association with multiple foetal malformations – a consequence of supra-physiological HCG?

Abstract

Aim: Hyperreactio luteinalis (HL) is characterised by ovarian cystic enlargement that is associated with high levels of human chorionic gonadotropin (hCG). Here the possible effects of abnormally high hCG levels on foetal development are demonstrated. Method: We report a 28-year-old patient who was referred for evaluation of bilateral maternal ovarian enlargement in the second trimester. Abnormally elevated hCG (887,514 IU/L) was found with ultrasound examination identifying various foetal malformations. The karyotype was normal. Spontaneous abortion occurred at 20 weeks. Autopsy showed testicular hypertrophy with marked Leydig cell hyperplasia. The HL resolved with normalisation of the hCG levels following delivery. Conclusion: HL is a rare finding in normal pregnancies; the potential effects of abnormally elevated hCG on the foetus are discussed.

Hyperreactio luteinalis associated with fetal hyperandrogenism and cystic hygroma

“…The exact cause of HL is still unclear 3 . Many cases were related to the elevated β‐hCG levels, typically over 300,000 IU, in association with a molar pregnancy, choriocarcinoma, or even large placenta as in multiple gestations 2,4,9 . However, as seen in this patient with spontaneous pregnancy and absence of previous ovarian stimulation, circulating β‐hCG levels can be normal in nearly 30% of patients 3 .…”