Spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma associated with primary hypothyroidism

Abstract

We report an unusual case of spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma in an adult, non-pregnant woman. Her condition was triggered by unrecognized primary hypothyroidism, which regressed after thyroid hormone replacement therapy. This case highlights the need for clinicians and radiologists to familiarize themselves with the clinical and imaging features detected in case of these complications of primary hypothyroidism, which are not well known in the medical and radiological profession. Such improved knowledge will help avoid delays in diagnosis, progression to lifethreatening complications, and unnecessary surgery.

Ovarian torsion and spontaneous ovarian hyperstimulation syndrome in a twin pregnancy: A case report

“…Several circumstances may increase the levels or biological activity of these glycoproteins:

Elevated endogenous levels of hCG can be seen in multiple pregnancies and gestational trophoblastic disease [2]. A variant of β-hCG with higher biological activity could also cause hyperstimulation of the FSHR [1], [8].

High TSH levels are seen in primary hypothyroidism [4], [8] and more rarely in TSH-secreting adenomas [1], [3], [5], [8]. Patients with spontaneous OHSS related to TSH can be treated with thyroid hormone replacement therapy, so they have a better prognosis [5], [8].…”

“…High TSH levels are seen in primary hypothyroidism [4], [8] and more rarely in TSH-secreting adenomas [1], [3], [5], [8]. Patients with spontaneous OHSS related to TSH can be treated with thyroid hormone replacement therapy, so they have a better prognosis [5], [8].…”

“…Patients with spontaneous OHSS related to TSH can be treated with thyroid hormone replacement therapy, so they have a better prognosis [5], [8]. The cysts normally regress 3–6 months after they develop [6].…”

“…Normally iatrogenic, OHSS mainly occurs in the context of infertility treatments and is extremely rare in spontaneous pregnancies [1], [2], [3], [4], [5]. In contrast with iatrogenic forms, which typically appear earlier [2], [4], [6], [7], spontaneous OHSS usually develops between the 8th and 14th weeks of gestation; it is sometimes familial and recurrent [6], and it can occur in non-pregnant women [5], [7], [8].…”

“…Explanations of the mechanisms that could trigger spontaneous OHSS focus on the follicle-stimulating hormone (FSH) receptor, which could be stimulated by high levels of FSH or other glycoprotein hormones with identical beta subunit [8], such as thyroid-stimulating hormone (TSH) [1], [5], [7], luteinizing hormone (LH), and chorionic gonadotrophin hormone (hCG). Mutations of the FSH receptor ( FSHR) gene that make the receptors more sensitive are probably also involved [1], [3], [7], [8].…”