1
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Chen J, Sun Q, Zhu T, Li K. Ovarian hyperstimulation syndrome and pregnancy luteoma mimicking malignant ascites: a rare case report. J Ovarian Res 2023; 16:97. [PMID: 37194026 DOI: 10.1186/s13048-023-01186-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/06/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND During pregnancy, both ovarian hyperstimulation syndrome (OHSS) and pregnancy luteoma could manifest as massive ascites, enlarged ovaries, or elevated serum levels of cancer antigen 125 (CA125), and atypical cells may be found in the ascitic fluid of OHSS patients. Whether this should be treated aggressively as peritoneal carcinomatosis is controversial. CASE PRESENTATION A 35-year-old G2P1A1 woman with secondary infertility had a successful pregnancy after one cycle of assisted reproductive technology. The patient complained of lower abdominal distension, oliguria, and poor appetite 19 days after embryo transplantation. She was diagnosed with late-onset OHSS. Although the size of the ovaries decreased bilaterally to the normal range at 12 weeks of gestation after prompt medical care, the ascites increased again after an initial decreasing trend. Elevated serum levels of CA125 (191.1 IU/mL), and suspected adenocarcinoma cells were observed in the ascitic fluid. Although further magnetic resonance imaging examination or diagnostic laparoscopy was recommended, the patient was provided with supportive treatment and closely monitored upon her request. Surprisingly, her ascites diminished, and serum level of CA125 started to decline at 19 weeks of gestation. During cesarean section, pathological examination of the solid mass in the right ovary revealed pregnancy luteoma, which was presumably the other cause of the intractable ascites. CONCLUSIONS Caution should be exercised in cases of suspicious malignant ascites during pregnancy. This may due to OHSS or pregnancy luteoma, in which abnormalities usually regress spontaneously.
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Affiliation(s)
- Jing Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave. Wuhan, Hubei, 430030, China
| | - Qian Sun
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave. Wuhan, Hubei, 430030, China
| | - Tao Zhu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave. Wuhan, Hubei, 430030, China
| | - Kezhen Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave. Wuhan, Hubei, 430030, China.
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2
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Ye BY, He P, Liu Y. Retrospective analysis of 26 cases of pregnancy luteoma. Technol Health Care 2023; 31:1825-1833. [PMID: 37125581 DOI: 10.3233/thc-220685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Pregnancy luteoma is a rare hormone-dependent ovarian tumor-like lesion caused by increased androgenic activity during pregnancy. OBJECTIVE To explore the clinical history, ultrasound manifestations, and differential diagnosis of pregnancy luteoma. METHOD A retrospective analysis was conducted on 26 cases of pregnancy luteoma diagnosed by postoperative pathology, from 2009 to 2022. All cases were from two hospitals: Shanghai First Maternity and Infant Hospital and International Peace Maternity and Child Health Hospital. The clinical history data and ultrasound characteristics were analyzed and the relevant literature was reviewed. RESULTS Among the 26 cases, five of them had preoperative ultrasound images. Among these five cases, three patients showed hyperechoic masses with less internal uniformity, while two demonstrated loculated anechoic zones, with clear boundary and regular morphology. Color Doppler showed no obvious internal blood flow signals, or that blood flow signals were visible within the cyst wall and hyperechoic mass. Among the cases, 16 had multiple gestations, while two visited the clinic due to sudden abdominal pain and a huge ovarian mass was found by ultrasonography. The ovarian lump was detected during routine obstetric ultrasound in three cases. The remaining were ovarian cysts found incidentally during caesarean section. Four patients presented with hairy manifestations and one patient had a deepened voice. CONCLUSION There is no characteristic ultrasound of pregnancy luteoma, and its diagnosis is mainly based on clinical history data and laboratory tests.
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Affiliation(s)
- Bao-Ying Ye
- Department of Ultrasonography, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ping He
- Department of Ultrasonography, Shanghai Key Laboratory of Maternal and Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuan Liu
- Department of Pathology, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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3
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McGee RG, Sinn J, Nyunt O. Unexpected cause of neonatal virilisation. J Paediatr Child Health 2022; 58:1083-1084. [PMID: 34651366 DOI: 10.1111/jpc.15753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/15/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Richard G McGee
- Paediatric Endocrinology, Gosford Hospital, Sydney, New South Wales, Australia
| | - John Sinn
- Sydney Medical School (Northern), The University of Sydney, Sydney, New South Wales, Australia.,Newborn Care, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ohn Nyunt
- Sydney Medical School (Northern), The University of Sydney, Sydney, New South Wales, Australia.,Department of Paediatric Diabetes and Endocrinology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Paediatric Endocrinology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, The University of New South Wales, Sydney, New South Wales, Australia
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4
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Combs E, Beachler T, Troy JR, Olds‐Sanchez A, Howard JM, Fales‐Williams A, Yaeger M, Tatarniuk DM. Luteoma in two mares treated by ovariectomy. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- E. Combs
- Department of Veterinary Clinical Sciences Iowa State University Ames Iowa USA
| | - T. Beachler
- Veterinary Diagnostic and Production Animal Medicine Iowa State University Ames Iowa USA
| | - J. R. Troy
- Department of Veterinary Clinical Sciences Iowa State University Ames Iowa USA
| | | | - J. M. Howard
- Department of Veterinary Clinical Sciences Iowa State University Ames Iowa USA
| | - A. Fales‐Williams
- Department of Veterinary Pathology Iowa State University Ames Iowa USA
| | - M. Yaeger
- Department of Veterinary Pathology Iowa State University Ames Iowa USA
| | - D. M. Tatarniuk
- Department of Veterinary Clinical Sciences Iowa State University Ames Iowa USA
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5
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Mvunta DH, Amiji F, Suleiman M, Baraka F, Abdallah I, Kazabula M, Wangwe PJT, August F. Hirsutism Caused by Pregnancy Luteoma in a Low-Resource Setting: A Case Report and Literature Review. Case Rep Obstet Gynecol 2021; 2021:6695117. [PMID: 33833884 PMCID: PMC8016591 DOI: 10.1155/2021/6695117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pregnancy luteomas are rare, benign, ovarian neoplasms resulting from increased androgenic activity during pregnancy. Often, they occur asymptomatically and are only diagnosed incidentally during imaging or surgery: cesarean section or postpartum tubal ligation. Most common symptoms associated with pregnancy luteoma include acne, deepening of voice, hirsutism, and clitoromegaly. Most pregnancy luteomas regress spontaneously postpartum. Thus, the management of pregnancy luteomas depends on the clinical situation. CASE We report a case of 28-year-old gravida 2, para 1 who presented at 39 + 1 weeks of gestation with prolonged labor and delivered by emergency cesarean. Intraoperatively, a huge left ovarian mass was identified and resected, and tissue was sent for histopathology and a diagnosis of pregnancy luteoma was made after the pathological report. CONCLUSION The present report emphasizes that pregnancy luteoma is a benign neoplasm and imprudent surgical intervention should be reserved. Proper imaging techniques, preferably MRI or ultrasonography that visualize the size of the ovary and reproductive hormonal profiles, would suffice for the diagnosis and management of pregnancy luteoma.
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Affiliation(s)
- David Hamisi Mvunta
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P.O. Box 65017, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynecology, Mawenzi Regional Referral Hospital, P.O. Box 3054, Moshi, Tanzania
| | - Fatemazahra Amiji
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P.O. Box 65017, Dar es Salaam, Tanzania
| | - Mubina Suleiman
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P.O. Box 65017, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynecology, Mnazi Mmoja Hospital, P.O. Box 236, Zanzibar, Tanzania
| | - Francisco Baraka
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P.O. Box 65017, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynecology, Maweni Regional Referral Hospital, P.O. Box 16, Kigoma, Tanzania
| | - Ikrah Abdallah
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P.O. Box 65017, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynecology, Kondoa District Hospital, P.O. Box 40, Dodoma, Tanzania
| | - Mabula Kazabula
- Department of Obstetrics and Gynecology, Lugalo Military Hospital, P.O. Box 60126, Mwenge, Dar es Salaam, Tanzania
| | - Peter J. T. Wangwe
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P.O. Box 65017, Dar es Salaam, Tanzania
| | - Furaha August
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P.O. Box 65017, Dar es Salaam, Tanzania
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6
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Hreha TN, Collins CA, Daugherty AL, Griffith JM, Hruska KA, Hunstad DA. Androgen-Influenced Polarization of Activin A-Producing Macrophages Accompanies Post-pyelonephritic Renal Scarring. Front Immunol 2020; 11:1641. [PMID: 32849562 PMCID: PMC7399094 DOI: 10.3389/fimmu.2020.01641] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022] Open
Abstract
Ascending bacterial pyelonephritis, a form of urinary tract infection (UTI) that can result in hospitalization, sepsis, and other complications, occurs in ~250,000 US patients annually; uropathogenic Escherichia coli (UPEC) cause a large majority of these infections. Although UTIs are primarily a disease of women, acute pyelonephritis in males is associated with increased mortality and morbidity, including renal scarring, and end-stage renal disease. Preclinical models of UTI have only recently allowed investigation of sex and sex-hormone effects on pathogenesis. We previously demonstrated that renal scarring after experimental UPEC pyelonephritis is augmented by androgen exposure; testosterone exposure increases both the severity of pyelonephritis and the degree of renal scarring in both male and female mice. Activin A is an important driver of scarring in non-infectious renal injury, as well as a mediator of macrophage polarization. In this work, we investigated how androgen exposure influences immune cell recruitment to the UPEC-infected kidney and how cell-specific activin A production affects post-pyelonephritic scar formation. Compared with vehicle-treated females, androgenized mice exhibited reduced bacterial clearance from the kidney, despite robust myeloid cell recruitment that continued to increase as infection progressed. Infected kidneys from androgenized mice harbored more alternatively activated (M2) macrophages than vehicle-treated mice, reflecting an earlier shift from a pro-inflammatory (M1) phenotype. Androgen exposure also led to a sharp increase in activin A-producing myeloid cells in the infected kidney, as well as decreased levels of follistatin (which normally antagonizes activin action). As a result, infection in androgenized mice featured prolonged polarization of macrophages toward a pro-fibrotic M2a phenotype, accompanied by an increase in M2a-associated cytokines. These data indicate that androgen enhancement of UTI severity and resulting scar formation is related to augmented local activin A production and corresponding promotion of M2a macrophage polarization.
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Affiliation(s)
- Teri N Hreha
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Christina A Collins
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Allyssa L Daugherty
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Jessie M Griffith
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Keith A Hruska
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States.,Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, United States
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States.,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, United States
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7
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Hreha TN, Collins CA, Daugherty AL, Twentyman J, Paluri N, Hunstad DA. TGFβ1 orchestrates renal fibrosis following Escherichia coli pyelonephritis. Physiol Rep 2020; 8:e14401. [PMID: 32227630 PMCID: PMC7104652 DOI: 10.14814/phy2.14401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/24/2020] [Indexed: 01/08/2023] Open
Abstract
Renal scarring after pyelonephritis is linked to long-term health risks for hypertension and chronic kidney disease. Androgen exposure increases susceptibility to, and severity of, uropathogenic Escherichia coli (UPEC) pyelonephritis and resultant scarring in both male and female mice, while anti-androgen therapy is protective against severe urinary tract infection (UTI) in these models. This work employed androgenized female C57BL/6 mice to elucidate the molecular mechanisms of post-infectious renal fibrosis and to determine how these pathways are altered by the presence of androgens. We found that elevated circulating testosterone levels primed the kidney for fibrosis by increasing local production of TGFβ1 before the initiation of UTI, altering the ratio of transcription factors Smad2 and Smad3 and increasing the presence of mesenchymal stem cell (MSC)-like cells and Gli1 + activated myofibroblasts, the cells primarily responsible for deposition of scar components. Increased production of TGFβ1 and aberrations in Smad2:Smad3 were maintained throughout the course of infection in the presence of androgen, correlating with renal scarring that was not observed in non-androgenized female mice. Pharmacologic inhibition of TGFβ1 signaling blunted myofibroblast activation. We conclude that renal fibrosis after pyelonephritis is exacerbated by the presence of androgens and involves activation of the TGFβ1 signaling cascade, leading to increases in cortical populations of MSC-like cells and the Gli1 + activated myofibroblasts that are responsible for scarring.
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Affiliation(s)
- Teri N. Hreha
- Department of PediatricsWashington University School of MedicineSt. LouisMOUSA
| | | | | | - Joy Twentyman
- Department of PediatricsWashington University School of MedicineSt. LouisMOUSA
- Present address:
Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Nitin Paluri
- Department of PediatricsWashington University School of MedicineSt. LouisMOUSA
| | - David A. Hunstad
- Department of PediatricsWashington University School of MedicineSt. LouisMOUSA
- Department of Molecular MicrobiologyWashington University School of MedicineSt. LouisMOUSA
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8
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Deknuydt M, Dumont A, Bruyneel A, Dewailly D, Catteau-Jonard S. Recurrent maternal virilization during pregnancy in patients with PCOS: two clinical cases. Reprod Biol Endocrinol 2018; 16:107. [PMID: 30376853 PMCID: PMC6208071 DOI: 10.1186/s12958-018-0428-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal 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 CASES Our 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. CONCLUSION Only 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.
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Affiliation(s)
- M. Deknuydt
- 0000 0004 0593 6676grid.414184.cService de Gynécologie Endocrinienne et Médecine de la Reproduction, Hôpital Jeanne de Flandre, CHRU Lille, 2 Avenue Eugène Avinée, 59037 Lille, France
| | - A. Dumont
- 0000 0004 0593 6676grid.414184.cService de Gynécologie Endocrinienne et Médecine de la Reproduction, Hôpital Jeanne de Flandre, CHRU Lille, 2 Avenue Eugène Avinée, 59037 Lille, France
| | - A. Bruyneel
- 0000 0004 0594 3884grid.418052.aCentre Hospitalier de Tourcoing, 155 rue du Président René Coty, 59200 Tourcoing, France
| | - D. Dewailly
- 0000 0004 0471 8845grid.410463.4Centre Hospitalier Régional Universitaire de Lille, 2 Avenue Oscar Lambret, 59037 Lille, France
| | - S. Catteau-Jonard
- 0000 0004 0593 6676grid.414184.cService de Gynécologie Endocrinienne et Médecine de la Reproduction, Hôpital Jeanne de Flandre, CHRU Lille, 2 Avenue Eugène Avinée, 59037 Lille, France
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9
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Kumar S, Gordon GH, Abbott DH, Mishra JS. Androgens in maternal vascular and placental function: implications for preeclampsia pathogenesis. Reproduction 2018; 156:R155-R167. [PMID: 30325182 PMCID: PMC6198264 DOI: 10.1530/rep-18-0278] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Adequate maternal vascular adaptations and blood supply to the uterus and placenta are crucial for optimal oxygen and nutrient transport to growing fetuses of eutherian mammals, including humans. Multiple factors contribute to hemodynamics and structuring of placental vasculature essential for term pregnancy with minimal complications. In women, failure to achieve or sustain favorable pregnancy progression is, not surprisingly, associated with high incidence of antenatal complications, including preeclampsia, a hypertensive disorder of pregnancy. While the pathogenesis of preeclampsia in women remains unknown, a role for androgens is emerging. The relationship between androgens and maternal cardiovascular and placental function deserves particular consideration because testosterone levels in the circulation of preeclamptic women are elevated approximately two- to three-fold and are positively correlated with vascular dysfunction. Preeclampsia is also associated with elevated placental androgen receptor (AR) gene expression. Studies in animal models mimicking the pattern and level of increase of adult female testosterone levels to those found in preeclamptic pregnancies, replicate key features of preeclampsia, including gestational hypertension, endothelial dysfunction, exaggerated vasoconstriction to angiotensin II, reduced spiral artery remodeling, placental hypoxia, decreased nutrient transport and fetal growth restriction. Taken together, these data strongly implicate AR-mediated testosterone action as an important pathway contributing to clinical manifestation of preeclampsia. This review critically addresses this hypothesis, taking into consideration both clinical and preclinical data.
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Affiliation(s)
- Sathish Kumar
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA.,Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.,Endocrinology-Reproductive Physiology Program, University of Wisconsin, Madison, Wisconsin, USA
| | - Geoffrey H Gordon
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - David H Abbott
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.,Endocrinology-Reproductive Physiology Program, University of Wisconsin, Madison, Wisconsin, USA.,Wisconsin National Primate Research Center, University of Wisconsin, Madison, Wisconsin, USA
| | - Jay S Mishra
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA
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10
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Duru Coteli SA, Orgul G, Salman MC. Pregnancy luteoma: a rare presentation and expectant management. CASE REPORTS IN PERINATAL MEDICINE 2018. [DOI: 10.1515/crpm-2018-0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Pregnancy luteoma (PL) is a rare cause of non-neoplastic masses in pregnancy. PLs are usually asymptomatic. However, general symptoms like pelvic pain, lumbalgia, constipation or virilization due to active hormone secretion can be detected as the clinical findings of these benign cysts. The definitive diagnosis of PL is most commonly possible with a pathological evaluation after surgical intervention. Therefore, we present a successful management of PL with close follow-up until delivery. Beside the suspicion of malignancy by ultrasonography and magnetic resonance imaging (MRI), the cytological evaluation of ascites revealed benign cells which was helpful to decide expectant management.
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Affiliation(s)
- Sinem Ayse Duru Coteli
- Hacettepe University Faculty of Medicine , Department of Obstetrics and Gynecology , 06100 Sıhhiye, Ankara , Turkey , Tel.: +90 537 784 06 07
| | - Gokcen Orgul
- Hacettepe University Faculty of Medicine , Department of Obstetrics and Gynecology , Division of Perinatology , Ankara , Turkey
| | - Mehmet Coskun Salman
- Hacettepe University Faculty of Medicine , Department of Obstetrics and Gynecology , Division of Gynecologic Oncology , Ankara , Turkey
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11
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Olson PD, McLellan LK, Hreha TN, Liu A, Briden KE, Hruska KA, Hunstad DA. Androgen exposure potentiates formation of intratubular communities and renal abscesses by Escherichia coli. Kidney Int 2018; 94:502-513. [PMID: 30041870 DOI: 10.1016/j.kint.2018.04.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/02/2018] [Accepted: 04/19/2018] [Indexed: 11/18/2022]
Abstract
Females across their lifespan and certain male populations are susceptible to urinary tract infections (UTI). The influence of female vs. male sex on UTI is incompletely understood, in part because preclinical modeling has been performed almost exclusively in female mice. Here, we employed established and new mouse models of UTI with uropathogenic Escherichia coli (UPEC) to investigate androgen influence on UTI pathogenesis. Susceptibility to UPEC UTI in both male and female hosts was potentiated with 5α-dihydrotestosterone, while males with androgen receptor deficiency and androgenized females treated with the androgen receptor antagonist enzalutamide were protected from severe pyelonephritis. In androgenized females and in males, UPEC formed dense intratubular, biofilm-like communities, some of which were sheltered from infiltrating leukocytes by the tubular epithelium and by peritubular fibrosis. Abscesses were nucleated by small intratubular collections of UPEC first visualized at five days postinfection and briskly expanded over the subsequent 24 hours. Male mice deficient in Toll-like receptor 4, which fail to contain UPEC within abscesses, were susceptible to lethal dissemination. Thus, androgen receptor activation imparts susceptibility to severe upper-tract UTI in both female and male murine hosts. Visualization of intratubular UPEC communities illuminates early renal abscess pathogenesis and the role of abscess formation in preventing dissemination of infection. Additionally, our study suggests that androgen modulation may represent a novel therapeutic route to combat recalcitrant or recurrent UTI in a range of patient populations.
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Affiliation(s)
- Patrick D Olson
- Medical Scientist Training Program, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lisa K McLellan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA; Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Teri N Hreha
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alice Liu
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kelleigh E Briden
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Keith A Hruska
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA.
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12
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Sherman SB, Sarsour N, Salehi M, Schroering A, Mell B, Joe B, Hill JW. Prenatal androgen exposure causes hypertension and gut microbiota dysbiosis. Gut Microbes 2018; 9:400-421. [PMID: 29469650 PMCID: PMC6219642 DOI: 10.1080/19490976.2018.1441664] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Conditions of excess androgen in women, such as polycystic ovary syndrome (PCOS), often exhibit intergenerational transmission. One way in which the risk for PCOS may be increased in daughters of affected women is through exposure to elevated androgens in utero. Hyperandrogenemic conditions have serious health consequences, including increased risk for hypertension and cardiovascular disease. Recently, gut dysbiosis has been found to induce hypertension in rats, such that blood pressure can be normalized through fecal microbial transplant. Therefore, we hypothesized that the hypertension seen in PCOS has early origins in gut dysbiosis caused by in utero exposure to excess androgen. We investigated this hypothesis with a model of prenatal androgen (PNA) exposure and maternal hyperandrogenemia by single-injection of testosterone cypionate or sesame oil vehicle (VEH) to pregnant dams in late gestation. We then completed a gut microbiota and cardiometabolic profile of the adult female offspring. RESULTS The metabolic assessment revealed that adult PNA rats had increased body weight and increased mRNA expression of adipokines: adipocyte binding protein 2, adiponectin, and leptin in inguinal white adipose tissue. Radiotelemetry analysis revealed hypertension with decreased heart rate in PNA animals. The fecal microbiota profile of PNA animals contained higher relative abundance of bacteria associated with steroid hormone synthesis, Nocardiaceae and Clostridiaceae, and lower abundance of Akkermansia, Bacteroides, Lactobacillus, Clostridium. The PNA animals also had an increased relative abundance of bacteria associated with biosynthesis and elongation of unsaturated short chain fatty acids (SCFAs). CONCLUSIONS We found that prenatal exposure to excess androgen negatively impacted cardiovascular function by increasing systolic and diastolic blood pressure and decreasing heart rate. Prenatal androgen was also associated with gut microbial dysbiosis and altered abundance of bacteria involved in metabolite production of short chain fatty acids. These results suggest that early-life exposure to hyperandrogenemia in daughters of women with PCOS may lead to long-term alterations in gut microbiota and cardiometabolic function.
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Affiliation(s)
- Shermel B. Sherman
- Department of Physiology and Pharmacology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Nadeen Sarsour
- Department of Biological Sciences, University of Toledo, Toledo, OH
| | - Marziyeh Salehi
- Department of Physiology and Pharmacology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Allen Schroering
- Department of Neurosciences and Neurological Disorders, The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Blair Mell
- Department of Physiology and Pharmacology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH,Center for Hypertension and Personalized Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Bina Joe
- Department of Physiology and Pharmacology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH,Center for Hypertension and Personalized Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Jennifer W. Hill
- Department of Physiology and Pharmacology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH,Center for Diabetes and Endocrine Research, The University of Toledo College of Medicine and Life Sciences, Toledo, OH,CONTACT Jennifer W. Hill, PhD Dept. of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Mail Stop 1008, 3000 Arlington Avenue, Toledo OH 43614
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Puttabyatappa M, Padmanabhan V. Developmental Programming of Ovarian Functions and Dysfunctions. VITAMINS AND HORMONES 2018; 107:377-422. [PMID: 29544638 PMCID: PMC6119353 DOI: 10.1016/bs.vh.2018.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The pathophysiological mechanisms underlying the origin of several ovarian pathologies remain unclear. In addition to the genetic basis, developmental insults are gaining attention as a basis for the origin of these pathologies. Such early insults include maternal over or under nutrition, stress, and exposure to environmental chemicals. This chapter reviews the development and physiological function of the ovary, the known ovarian pathologies, the developmental check points of ovarian differentiation impacted by developmental insults, the role played by steroidal and metabolic factors as mediaries, the epigenetic mechanisms via which these mediaries induce their effects, and the knowledge gaps for targeting future studies to ultimately aid in the development of improved treatments.
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Nishina H, Izawa T, Ozaki M, Kuwamura M, Yamate J. Unilateral luteoma of the ovary in a pregnant Risso's dolphin (Grampus griseus). J Vet Med Sci 2017; 79:1749-1752. [PMID: 28845023 PMCID: PMC5658572 DOI: 10.1292/jvms.17-0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A white, lobular mass was found in the right ovary of a pregnant Risso’s dolphin
(Grampus griseus) at necropsy. The mass was unilateral and occupied
most of the pre-existing ovarian tissue. Histologically, the mass was composed of diffuse
sheets of polyhedral cells with abundant eosinophilic cytoplasm and oval nuclei, separated
by fibrous connective tissue. Only a few ovarian follicles were observed at the periphery
of the mass. Immunohistochemically, the large eosinophilic cells were positive for
vimentin and negative for pan-cytokeratins. Based on the histopathological features, the
present case was diagnosed as luteoma. In human medicine, luteoma of pregnancy, a
tumor-like proliferative lesion occurring in pregnant women, is well described. In
veterinary medicine, luteoma associated with pregnancy has never been described. The
present study would provide useful information for understanding the characteristics of
luteoma in animals.
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Affiliation(s)
- Hironobu Nishina
- Laboratory of Veterinary Pathology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-Ourai-Kita, Izumisano, Osaka 598-8531, Japan
| | - Takeshi Izawa
- Laboratory of Veterinary Pathology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-Ourai-Kita, Izumisano, Osaka 598-8531, Japan
| | - Miki Ozaki
- Adventure World AWS Co., Ltd., 2399 Nishimuro-gun, Shirahama-cho, Katada, Wakayama 649-2201, Japan
| | - Mitsuru Kuwamura
- Laboratory of Veterinary Pathology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-Ourai-Kita, Izumisano, Osaka 598-8531, Japan
| | - Jyoji Yamate
- Laboratory of Veterinary Pathology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-Ourai-Kita, Izumisano, Osaka 598-8531, Japan
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Rathore R, Katyal A, Shilpi, Nargotra N. Luteoma of Pregnancy Masquerading as Ectopic Pregnancy: Lessons Learnt. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2017; 5:281-283. [PMID: 30787804 PMCID: PMC6298296 DOI: 10.4103/sjmms.sjmms_50_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ruchi Rathore
- Department of Pathology, Hindu Rao Hospital, New Delhi, India
| | - Akshi Katyal
- Department of Pathology, Hindu Rao Hospital, New Delhi, India
| | - Shilpi
- Department of Pathology, Hindu Rao Hospital, New Delhi, India
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16
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Bishop LA, Patel S, Fries MH. A case of recurrent hyperreactio luteinalis in three spontaneous pregnancies. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:502-505. [PMID: 26892678 DOI: 10.1002/jcu.22343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/11/2016] [Accepted: 01/20/2016] [Indexed: 06/05/2023]
Abstract
Hyperreactio luteinalis is a rare condition in pregnancy characterized by enlarged ovaries with multiple theca luteal cysts, and recurrence of disease has seldom been documented in the literature. This is a case report of a woman who developed recurrent hyperreactio luteinalis with three spontaneous pregnancies. Endocrine evaluation was performed and revealed hyperandrogenism. Ultrasonography was used to assess the ovaries throughout each pregnancy. The ovarian cysts required drainage in the first pregnancy due to severe distention and shortness of breath. Cyst resolution occurred in the post-partum period following each pregnancy. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:502-505, 2016.
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Affiliation(s)
- Lauren A Bishop
- Shady Grove Fertility Reproductive Science Center, 15001 Shady Grove Rd., Rockville, MD, 20850.
| | - Shaila Patel
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, 20007
| | - Melissa H Fries
- Washington Hospital Center, Department of Obstetrics and Gynecology, 110 Irving Street NW, Washington, DC, 20010
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17
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Barrett ES, Parlett LE, Redmon JB, Swan SH. Evidence for sexually dimorphic associations between maternal characteristics and anogenital distance, a marker of reproductive development. Am J Epidemiol 2014; 179:57-66. [PMID: 24124194 DOI: 10.1093/aje/kwt220] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Data from animal models, historical cohorts, and modern epidemiologic studies have suggested that maternal characteristics can affect reproductive health of offspring; however, distinguishing between prenatal and postnatal contributions is difficult. Anogenital distance (AGD), the distance from the anus to the genitals, is believed to be a biomarker of prenatal androgen exposure in many species, and in humans it has been associated with several adult reproductive health outcomes. We used data from a pregnancy cohort study conducted in 4 US cities from 1999-2005 to examine whether AGD measurements in infants were associated with maternal self-reported age at conception, age at menarche, age at first birth, parity, and gravidity. AGD was measured in 289 infants (140 male, 149 female) born to study participants. After adjustment for relevant covariates, in linear regression models stratified by infant sex, maternal age was positively associated with AGD in male infants (AGD, anus to penis: β = 0.50, P = 0.002; AGD, anus to scrotum: β = 0.29, P = 0.02) but not female infants. Parity was inversely associated with AGD (anus to scrotum; β = -1.68, P = 0.03) in male infants. No other maternal characteristic predicted AGD in either sex. The mechanism underlying the unexpected relationship between maternal characteristics and AGD is unknown; however, we suggest several possibilities for future study.
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18
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Sun M, Maliqueo M, Benrick A, Johansson J, Shao R, Hou L, Jansson T, Wu X, Stener-Victorin E. Maternal androgen excess reduces placental and fetal weights, increases placental steroidogenesis, and leads to long-term health effects in their female offspring. Am J Physiol Endocrinol Metab 2012; 303:E1373-85. [PMID: 23047983 DOI: 10.1152/ajpendo.00421.2012] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Here, we tested the hypothesis that excess maternal androgen in late pregnancy reduces placental and fetal growth, increases placental steroidogenesis, and adversely affects glucose and lipid metabolism in adult female offspring. Pregnant Wistar rats were randomly assigned to treatment with testosterone (daily injections of 5 mg of free testosterone from gestational days 16 to 19) or vehicle alone. In experiment 1, fetal and placental weights, circulating maternal testosterone, estradiol, and corticosterone levels, and placental protein expression and distribution of estrogen receptor-α and -β, androgen receptor, and 17β-hydroxysteroid dehydrogenase 2 were determined. In experiment 2, birth weights, postnatal growth rates, circulating testosterone, estradiol, and corticosterone levels, insulin sensitivity, adipocyte size, lipid profiles, and the presence of nonalcoholic fatty liver were assessed in female adult offspring. Treatment with testosterone reduced placental and fetal weights and increased placental expression of all four proteins. The offspring of testosterone-treated dams were born with intrauterine growth restriction; however, at 6 wk of age there was no difference in body weight between the offspring of testosterone- and control-treated rats. At 10-11 wk of age, the offspring of the testosterone-treated dams had less fat mass and smaller adipocyte size than those born to control rats and had no difference in insulin sensitivity. Circulating triglyceride levels were higher in the offspring of testosterone-treated dams, and they developed nonalcoholic fatty liver as adults. We demonstrate for the first time that prenatal testosterone exposure alters placental steroidogenesis and leads to dysregulation of lipid metabolism in their adult female offspring.
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Affiliation(s)
- Miao Sun
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abstract
The ovary is a complex structure that is responsible for maintaining the endocrine support for a pregnancy during the first trimester until the placenta is sufficiently developed to assume this role. Most ovarian disorders of pregnancy actually relate to pre-existing ovarian conditions such as polycystic ovary syndrome and premature ovarian insufficiency. Both of these are associated with increased complications in pregnancy and require careful monitoring. Ovarian disorders that are a particular consequence of the hormonal milieu of pregnancy such as pregnancy luteoma (PL) and hyperreactio luteinalis (HL) are rare. However, they have important implications for both the mother and the foetus since they can be confused with ovarian malignancy leading to unnecessary surgery. This review focuses on the salient aspects of management of these ovarian conditions during pregnancy.
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Affiliation(s)
- Niamh Phelan
- Department of Endocrinology, University College London Hospitals, UK.
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20
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Sathishkumar K, Elkins R, Chinnathambi V, Gao H, Hankins GDV, Yallampalli C. Prenatal testosterone-induced fetal growth restriction is associated with down-regulation of rat placental amino acid transport. Reprod Biol Endocrinol 2011; 9:110. [PMID: 21812961 PMCID: PMC3162507 DOI: 10.1186/1477-7827-9-110] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 08/03/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Exposure of pregnant mothers to elevated concentrations of circulating testosterone levels is associated with fetal growth restriction and delivery of small-for-gestational-age babies. We examined whether maternal testosterone crosses the placenta to directly suppress fetal growth or if it modifies placental function to reduce the capacity for transport of nutrients to the fetus. METHODS Pregnant rats were exposed to testosterone propionate (TP; 0.5 mg/kg) by daily subcutaneous injection from gestational days (GD) 15-19. Maternal and fetal testosterone levels, placental nutrient transport activity and expression of transporters and birth weight of pups and their anogenital distances were determined. RESULTS This dose of TP doubled maternal testosterone levels but had no effect on fetal testosterone levels. Maternal daily weight gain was significantly lower only on GD 19 in TP treated dams compared to controls. Placental weight and birth weight of pups were significantly reduced, but the anogenital distance of pups were unaffected by TP treatment. Maternal plasma amino acids concentrations were altered following testosterone exposure, with decreases in glutamine, glycine, tyrosine, serine, proline, and hydroxyproline and increases in asparagine, isoleucine, leucine, lysine, histidine and arginine. In the TP dams, placental system A amino acid transport activity was significantly reduced while placental glucose transport capacity was unaffected. Decreased expression of mRNA and protein levels of slc38a2/Snat2, an amino acid transporter, suggests that reduced transporter proteins may be responsible for the decrease in amino acid transport activity. CONCLUSIONS Taken together, these data suggest that increased maternal testosterone concentrations do not cross the placenta to directly suppress fetal growth but affects amino acid nutrient delivery to the fetus by downregulating specific amino acid transporter activity.
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Affiliation(s)
- Kunju Sathishkumar
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch Galveston, Texas, USA
| | - Rebekah Elkins
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch Galveston, Texas, USA
| | - Vijayakumar Chinnathambi
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch Galveston, Texas, USA
| | - Haijun Gao
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch Galveston, Texas, USA
| | - Gary DV Hankins
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch Galveston, Texas, USA
| | - Chandra Yallampalli
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch Galveston, Texas, USA
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Abstract
Hyperandrogenic states in pregnancy are almost always the result of a condition that arises during pregnancy. The onset of virilization symptoms is often very fast. The mother is protected against hyperandrogenism by a high level of SHBG, by placental aromatase and a high level of progesterone. The fetus is protected from the mother’s hyperandrogenism partly by the placental aromatase, that transforms the androgens into estrogens, and partly by SHGB. Nevertheless there is a significant risk of virilization of the female fetus if the mother’s hyperandrogenic state is serious. The most frequent cause of hyperandrogenic states during pregnancy are pregnancy luteoma and hyperreactio luteinalis. Hormonal production is evident in a third of all luteomas, which corresponds to virilization in 25-35 % of mothers with luteoma. The female fetus is afflicted with virilization with two thirds of virilized mothers. Hyperreactio luteinalis is created in connection with a high level of hCG, e.g. during multi-fetus pregnancies. This condition most frequently arises in the third trimester, virilization of the mother occurs in a third of cases. Virilization of the fetus has not yet been described. The most serious cause of hyperandrogenism is represented by ovarian tumors, which are fortunately rare.
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Affiliation(s)
- N. KAŇOVÁ
- Institute of Endocrinology, Prague, Czech Republic
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Prenatal virilization associated with paternal testosterone gel therapy. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2010; 2010:867471. [PMID: 20976267 PMCID: PMC2952944 DOI: 10.1155/2010/867471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 09/27/2010] [Indexed: 11/24/2022]
Abstract
Transdermal testosterone gels are used in the treatment of hypoandrogenism of males. Virilization due to exposure to testosterone gels has been reported in children resulting in a US Food and Drug Administration (FDA) warning about secondary exposure to these products. At present, we are unaware of prenatal virilization associated with unintentional testosterone gel exposure. We report prenatal virilization in a female infant due to secondary maternal exposure to the father's testosterone gel. We also describe postnatal virilization of the child's twin sister.
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Chitayat D, Glanc P. Diagnostic approach in prenatally detected genital abnormalities. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:637-646. [PMID: 20521311 DOI: 10.1002/uog.7679] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Patel A, Rivkees S. Prenatal Virilization Associated with Paternal Testosterone Gel Therapy. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2010. [DOI: 10.1186/1687-9856-2010-867471] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Chen CH, Chen IC, Wang YC, Liu JY, Wu GJ, Tzeng CR. Boy born after gender preselection following successive gestational androgen excess of maternal luteoma and female disorders of sex development. Fertil Steril 2008; 91:2732.e5-7. [PMID: 19110243 DOI: 10.1016/j.fertnstert.2008.10.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 10/21/2008] [Accepted: 10/22/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To present male gender preselection after successive gestational hyperandrogenism and female pseudohermaphroditism by pregnancy luteomas. DESIGN Case report. SETTING University-based teaching hospital. PATIENT(S) We describe herein a gravida who presented two successive 46, XX disorders of sex development with apparent female genitalia with an enlarged clitoris due to maternal androgen excess from pregnancy luteoma. The maternal hyperandrogenemia returned to a normal level and bilateral luteoma regressed spontaneously postpartum. After gender preselection by Y-bearing spermatozoa for intrauterine insemination at the third gestation, a healthy boy was born in spite of the exaggerated maternal androgen production of pregnancy luteoma to avoid 46, XX disorders of sex development. INTERVENTION(S) Y-bearing spermatozoa for intrauterine insemination as male gender preselection. MAIN OUTCOME MEASURE(S) Boy born after gender preselection for intrauterine insemination and cesarean section. RESULT(S) Healthy boy born without disorder of sex development after antenatal maternal androgen excess of ovarian luteoma. CONCLUSION(S) Successive pregnancy luteomas associated with maternal hyperandrogenism may cause female disorders of sex development. Male preselection ameliorates the insult of external genitalia ambiguity by antenatal androgen excess in this matter of concern.
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Affiliation(s)
- Chi-Huang Chen
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taiwan.
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Dahl SK, Thomas MA, Williams DB, Robins JC. Maternal virilization due to luteoma associated with delayed lactation. Fertil Steril 2008; 90:2006.e17-9. [PMID: 18635167 DOI: 10.1016/j.fertnstert.2008.01.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 01/11/2008] [Accepted: 01/14/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To report on a patient with virilization during pregnancy who experienced delayed lactation secondary to elevated maternal androgens. DESIGN Case report and review of the literature. SETTING University hospital. PATIENT(S) A 32-year-old pregnant woman presented with virilization at 32 weeks' gestation. INTERVENTION(S) Laboratory evaluation, ultrasound examination, magnetic resonance imaging, cesarean section for fetal indication, nipple stimulation to facilitate lactation. MAIN OUTCOME MEASURE(S) Case report. RESULT(S) Postpartum normalization of serum T levels and patient ability to breastfeed exclusively after delayed initiation of lactation. CONCLUSION(S) Maternal virilization during pregnancy is rare and is often due to androgen-secreting tumors that are benign. Therefore, careful evaluation of these patients is important to avoid inadvertent oophorectomy.
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Affiliation(s)
- Stephanie K Dahl
- Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
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Spitzer RF, Wherrett D, Chitayat D, Colgan T, Dodge JE, Salle JLP, Allen L. Maternal Luteoma of Pregnancy Presenting With Virilization of the Female Infant. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2007; 29:835-40. [PMID: 17915067 DOI: 10.1016/s1701-2163(16)32642-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Virilization in female newborns typically results from congenital adrenal hyperplasia, requiring immediate diagnosis and treatment. We report a rare cause of virilization, maternal pregnancy luteoma, responsible for virilization of both a newborn and the mother. Luteomas are usually asymptomatic tumour-like ovarian lesions of pregnancy that secrete androgens in only 25% of cases. Many female infants born to masculinized mothers will also be virilized. CASE A term infant born with ambiguous genitalia was transferred to a referral centre for investigation, diagnosis, and treatment. Assessment identified Prader II-III genitalia, an elevated serum testosterone level, a normal serum 17-hydroxyprogesterone level, and a normal female karyotype (46,XX). The mother had had virilization from the second trimester and was found to have an elevated serum testosterone level. Pelvic ultrasound assessment in the mother showed a complex right ovarian mass. Laparotomy was performed, and the mass was excised. Histopathology examination confirmed a luteoma. CONCLUSION High maternal serum testosterone levels due to a luteoma can result in virilization in the female newborn. This report emphasizes the need to consider possible underlying maternal pathology in evaluating a virilized female infant.
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Affiliation(s)
- Rachel F Spitzer
- Section of Gynecology, Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto ON
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Oztekin O, Soylu F, Tatli O. Spontaneous Ovarian Hyperstimulation Syndrome in a Normal Singleton Pregnancy. Taiwan J Obstet Gynecol 2006; 45:272-5. [PMID: 17175480 DOI: 10.1016/s1028-4559(09)60241-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE It is known that most cases of ovarian hyperstimulation syndrome (OHSS) are associated with the therapies for ovulation induction. However, OHSS may rarely be associated with a spontaneous ovulatory cycle, usually in the case of multiple gestations, hypothyroidism or polycystic ovary syndrome. CASE REPORT A case of OHSS in a woman who became pregnant naturally and who had no underlying disease is presented here. The patient was managed expectantly with no complications. CONCLUSION Although spontaneous ovarian hyperstimulation is a rare entity, it is important to differentiate it from other causes of ovarian enlargement. Occasionally, life-threatening situations may occur, but it is usually a self-limiting process.
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Affiliation(s)
- Ozer Oztekin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
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