Recurrent maternal virilization during pregnancy in patients with PCOS: two clinical cases

Abstract

BackgroundMaternal virilization during pregnancy is a rare phenomenon. Polycystic ovary syndrome (PCOS), luteoma and luteinic cysts are the most frequent and benign etiologies. This article presents two cases of recurrent maternal virilization during pregnancy.Clinical casesOur reported cases were young women with Afro-Caribbean and Nigerian origins. Data were collected by history-taking, clinical examination, laboratory investigations, transabdominal ultrasonographic examination and Magnetic Resonance Imaging. Both patients were diagnosed with PCOS according to the Rotterdam criteria. During each of their pregnancies they both developed an explosive hirsutism, a deepening in the voice, a clitoromegaly. Gestational diabetes occurred during pregnancies. There was no fetal virilization, despite raising androgen levels, more than tenfold to normal. Improvement of hirsutism and normalization of androgens were described in postpartum.ConclusionOnly few cases of maternal virilization during pregnancy were reported in literature and even fewer concern recurrent and bilateral ovarian etiology. Hyperplasia of ovarian theca cells seems to be the most likely explanation, which would suggest that PCOS belongs to a spectrum of abnormal reactivity of the ovary to human Chorionic Gonadotrophin (hCG) stimulation along with luteoma and luteinic cyst of pregnancy. Insulin resistance could worsen hyperandrogenism but is not enough to explain virilization. Treatment should focus on protecting the fetus of possible virilization as well as its mother, but also on preserving the subsequent fertility in both.

Hirsutism Caused by Pregnancy Luteoma in a Low-Resource Setting: A Case Report and Literature Review

“…An occurrence preponderance has been noted among the Afro-Caribbean around the ages of 30 and 40 years old and those with preexisting PCOS [ 11 ]. PCOS contributes to high β -hCG hormone levels favoring the proliferation of pregnancy luteoma [ 2 , 26 ]. These findings on age of occurrence are consistent with our case report.…”

More Than Meets the Eye in a Patient With Pcos: Androgen-Secreting Granulosa Cell Ovarian Tumor in a Virilized Woman With Polycystic Ovarian Syndrome (Pcos)

“…Hirsutism and infertility due to anovulatory menstrual cycles and/or amenorrhea are usual manifestations of PCOS (1-6). Moreover, data regarding PCOS causing virilization is sparse in the literature (7). Anecdotal or literature reports of virilization including male pattern baldness and male hair distribution (e.g., beard and mustache requiring daily shaving), as well as clitoral hypertrophy are rare.…”

“…(AACE Clinical Case Rep. 2020;6:e170-e173) Abbreviation: PCOS = polycystic ovary syndrome INTRODUCTION Hirsutism, infertility, irregular menstrual cycles, and anovulation are hallmarks of polycystic ovarian syndrome (PCOS) (1-6). However, virilization is rarely described (7). Herein, we report a young woman treated with metformin and oral contraceptives or spironolactone for several years following a diagnosis of PCOS because of a history of primary amenorrhea and virilization despite lack of remission, and the onset and progression of type 2 diabetes.…”

Impaired Lactation: Review of Delayed Lactogenesis and Insufficient Lactation

“…Attempts to breastfeed were not made after her third or fourth pregnancies. Interestingly, her androgen levels, which included testosterone, were elevated during the first trimester, peaked at the end of pregnancy, and then spontaneously decreased by 2 weeks postpartum and returned to normal by one month postpartum 46 …”