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Zhou J, Chen Y, Bai L, Zhou W, Yang H, Chen Y, Chen L, Lu R, Hu L, Wang S. Ovarian Hyperstimulation syndrome combined with hypothyroidism: a comprehensive review. J Ovarian Res 2024; 17:98. [PMID: 38725001 PMCID: PMC11084021 DOI: 10.1186/s13048-024-01406-3] [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] [Received: 02/27/2024] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
Ovarian Hyperstimulation Syndrome (OHSS) is a systemic condition marked by the enlargement of the ovaries and heightened vascular permeability. And hypothyroidism (HT) emerges as a potential risk factor for OHSS occurrence. This review presented a comprehensive summary of pertinent case reports involving patients diagnosed with both HT and OHSS. Detailed exploration was conducted into their clinical presentations, diagnostic methodologies, and treatment modalities. Additionally, the review delved into potential interaction mechanisms between HT and OHSS, encompassing various aspects including hormone levels. Moreover, management strategies for mitigating the risk of OHSS in HT patients were thoroughly reviewed and the importance of monitoring thyroid function in those experiencing OHSS was emphasized. This review indicated that the association between HT and OHSS, underscoring its multifaceted complexity. It could accentuate the ongoing necessity for rigorous research and clinical refinement to deepen our comprehension of this association and to bolster diagnostic and therapeutic methodologies for optimal patient care. In conclusion, this review offered valuable insights for future research directions and clinical practices for patients afflicted with OHSS and HT.
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Affiliation(s)
- Jing Zhou
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Yu Chen
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Lijing Bai
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Wei Zhou
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Haiyan Yang
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Yang Chen
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Li Chen
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Renjie Lu
- Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
- Changzhou Institute for Advanced Study of Public Health, Nanjing Medical University, Nanjing, 210000, Jiangsu, China
| | - Lingmin Hu
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China.
| | - Shuxian Wang
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China.
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Chai W, He H, Li F, Zhang W, He C. Spontaneous ovarian hyperstimulation syndrome in a nonpregnant female patient: a case report and literature review. J Int Med Res 2021; 48:300060520952647. [PMID: 32985302 PMCID: PMC7536485 DOI: 10.1177/0300060520952647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Spontaneous ovarian hyperstimulation syndrome (sOHSS) usually occurs in patients with a
spontaneous ovulation cycle, especially in those with multiple pregnancies combined with
hypothyroidism and polycystic ovary syndrome. sOHSS rarely occurs in women who are not
pregnant. A 23-year-old woman with obvious abdominal distension visited our hospital. The
patient was not pregnant and had not undergone controlled superovulation. Apart from
abdominal distension, the patient denied any symptom of obvious incentives, abdominal
pain, abnormal vaginal bleeding, or drainage. Biochemical analysis showed a high
carbohydrate antigen-125 level and low total protein and albumin levels. Abdominal
ultrasound and computed tomography showed a large amount of ascites and cystic uneven
masses with an irregular shape in the area of the ovaries and fallopian tubes.
Post-surgical histopathology indicated the diagnosis of sOHSS. Wedge resection of both
ovaries was performed. Symptomatic treatment was further performed and the patient
recovered well. Our findings indicate that sOHSS can occur in women who are not pregnant.
Additionally, besides the follicle-stimulating hormone receptor gene mutation hypothesis,
the pathogenesis of sOHSS should be further studied.
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Affiliation(s)
- Wei Chai
- Department of Gynecology and Obstetrics, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hongyu He
- Operating Theater and Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Fei Li
- Department of Gynecology and Obstetrics, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Wenlei Zhang
- Department of Interventional Therapy, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Chao He
- Department of Gynecology and Obstetrics, The First Hospital of Jilin University, Changchun, Jilin, China
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Al-Shukri MN, Gowri V, Al-Ghafri WM, Nair A. Indications for Abdominal Surgery in Spontaneous Ovarian Hyperstimulation: A Literature Review. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2018.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maryam Nasser Al-Shukri
- Department of Obstetrics and Gynecology, College of Medicine, Sultan Qaboos University, Al-Khoudh, Muscat, Sultanate of Oman
| | - Vaidyanathan Gowri
- Department of Obstetrics and Gynecology, College of Medicine, Sultan Qaboos University, Al-Khoudh, Muscat, Sultanate of Oman
| | - Wadha Mohammed Al-Ghafri
- Department of Obstetrics and Gynecology, College of Medicine, Sultan Qaboos University, Al-Khoudh, Muscat, Sultanate of Oman
| | - Asha Nair
- Department of Obstetrics and Gynecology, College of Medicine, Sultan Qaboos University, Al-Khoudh, Muscat, Sultanate of Oman
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Yang L, Wang R, Wang F, Wang F, Zou L. Ovarian hyperstimulation syndrome in a frozen-thawed embryo transfer pregnancy: a rare case report. BMC Pregnancy Childbirth 2020; 20:313. [PMID: 32434545 PMCID: PMC7238628 DOI: 10.1186/s12884-020-03014-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 05/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovarian stimulation. Prevention and early recognition of OHSS are important to ensure patient safety. Case presentation In this case, we reported a patient who underwent controlled ovarian hyperstimulation (COH) and in vitro fertilization (IVF). All embryos were cryopreserved to reduce possible OHSS. However, OHSS still occurred after the patient had a frozen-thawed embryo transfer (FET) with hormone replacement therapy (HRT) and obtained a dichorionic diamniotic triplet pregnancy. After multifetal pregnancy reduction (MFPR) and supportive treatment, all the symptoms regressed. Conclusions Prompt recognition of OHSS, especially in patients who have no history of ovulation induction and fresh embryo transfer, is very important. Multiple pregnancies may lead to severe OHSS because of the high level of human chorionic gonadotropin (hCG) in the early stages. We suggest that a single embryo transfer may be necessary and beneficial for patients.
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Affiliation(s)
- Lihua Yang
- Department of Reproductive Medicine, Jinhua People's Hospital, Jinhua, 321000, Zhejiang, China.
| | - Rong Wang
- Department of Reproductive Medicine, Jinhua People's Hospital, Jinhua, 321000, Zhejiang, China
| | - Fang Wang
- Department of Reproductive Medicine, Jinhua People's Hospital, Jinhua, 321000, Zhejiang, China
| | - Feifeng Wang
- Department of Reproductive Medicine, Jinhua People's Hospital, Jinhua, 321000, Zhejiang, China.
| | - Libo Zou
- Department of Reproductive Medicine, Jinhua People's Hospital, Jinhua, 321000, Zhejiang, China
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Morotti E, Battaglia C. Oligosypthomatic ovarian hyperstimulation syndrome in a spontaneous uneventful pregnancy. A case report. Gynecol Endocrinol 2019; 35:657-660. [PMID: 30806108 DOI: 10.1080/09513590.2019.1579791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Spontaneous hyperstimulation syndrome (spOHSS) is a rare event in pregnancies following natural conception. Only a few cases are reported in the scientific literature and result associated with massive ovarian enlargement with multiple cysts, dehydration, and fluid accumulation in the "third space". We report a novel case of spOHSS in a naturally conceived singleton pregnancy. The spOHSS was characterized by massive ovarian enlargement with multiple cysts. No dehydration and no signs of ascites were observed. The pregnancy uneventful evolved up to term.
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Affiliation(s)
- Elena Morotti
- a Department of Obstetrics and Gynecology , Alma Mater Studiorum-University of Bologna , Bologna , Italy
| | - Cesare Battaglia
- a Department of Obstetrics and Gynecology , Alma Mater Studiorum-University of Bologna , Bologna , Italy
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Celik S, Soyer-Calıskan C, Hatirnaz S, Celik H, Tosun M, Hatirnaz ES. Lifesaving dose increment of cabergoline in life-threatening spontaneous ovarian hyperstimulation syndrome resistant to all interventions. Gynecol Endocrinol 2019; 35:287-289. [PMID: 30560702 DOI: 10.1080/09513590.2018.1525703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Spontaneous ovarian hyperstimulation syndrome (SOHSS) is an extremely rare complication that deserves a multidisciplinary approach together with a thorough investigation for the correct diagnosis of the underlying pathology. The aim of this study was to present a case of severe SOHSS resistant to all interventions and to discuss the available interventions to overcome such a rare and serious clinical situation. CASE REPORT We report a case of severe, life-threatening spontaneous OHSS with a normal nine weeks singleton pregnancy in a 25-year-old nulliparous woman, which resulted with pregnancy termination and continuation of disease progression until the dose of cabergoline was increased to 1.5 mg/day. CONCLUSION This case report emphasizes that patients with life-threatening SOHSS resistant to all medical and surgical interventions may benefit from higher doses of cabergoline. Although spontaneous OHSS is extremely rare, it is potentially a life-threatening clinical entity in its severe form and needs time management and detailed examination of the underlying causes.
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Affiliation(s)
- Samettin Celik
- a Maternity Hospital, A Branch of Training and Research Hospital , Samsun , Turkey
| | - Canan Soyer-Calıskan
- a Maternity Hospital, A Branch of Training and Research Hospital , Samsun , Turkey
| | - Safak Hatirnaz
- b IVF Center , Medicana International Hospital , Samsun , Turkey
| | - Handan Celik
- c Department of Obstetrics and Gynecology , Ondokuzmayıs University , Samsun , Turkey
| | - Miğraci Tosun
- c Department of Obstetrics and Gynecology , Ondokuzmayıs University , Samsun , Turkey
| | - Ebru S Hatirnaz
- b IVF Center , Medicana International Hospital , Samsun , Turkey
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First mutation in the FSHR cytoplasmic tail identified in a non-pregnant woman with spontaneous ovarian hyperstimulation syndrome. BMC MEDICAL GENETICS 2017; 18:44. [PMID: 28446136 PMCID: PMC5405471 DOI: 10.1186/s12881-017-0407-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/14/2017] [Indexed: 02/07/2023]
Abstract
Background Spontaneous ovarian hyperstimulation syndrome (sOHSS) is a rare event occurring mostly during natural pregnancy. Among described etiologies, some activating mutations of FSH receptor (FSHR) have been identified. Case presentation We report hereby the case of a non-pregnant women with three episodes of sOHSS. Hormonal evaluation was normal and no pituitary adenoma was detected. However, genetic analysis identified a novel heterozygous FSHR mutation (c.1901 G > A). This R634H mutation is the first described in the cytoplasmic tail of the receptor. Functional analysis failed to reveal constitutive activity of the mutant but a decreased cAMP production in response to FSH. The weak activity of this mutant is correlated with a markedly reduced cell surface expression. Conclusion Pathophysiology of non gestationnal sOHSS is still ill established. The molecular characterization of this new mutant indicates that it might not be at play. Therefore, further investigations are needed to improve knowledge of the molecular mechanism of this syndrome.
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Gil Navarro N, Garcia Grau E, Pina Pérez S, Ribot Luna L. Ovarian torsion and spontaneous ovarian hyperstimulation syndrome in a twin pregnancy: A case report. Int J Surg Case Rep 2017; 34:66-68. [PMID: 28371633 PMCID: PMC5377435 DOI: 10.1016/j.ijscr.2017.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/06/2017] [Accepted: 03/10/2017] [Indexed: 12/15/2022] Open
Abstract
Spontaneous ovarian hyperstimulation syndrome (OHSS) can result from hyperstimulation of the follicle-stimulating hormone (FSH) receptor by FSH or other glycoprotein hormones such as chorionic gonadotrophin hormone (hCG), thyroid-stimulating hormone (TSH), and luteinizing hormone (LH); mutations of the FSH receptor gene can make these receptors abnormally sensitive to hCG, TSH, or both. In patients with ovarian cysts and suspected spontaneous OHSS, it is important to determine whether hydatidiform mole, multiple pregnancie, hypothyroidism, glycoprotein-secreting adenoma or FSH receptor mutation are present. Although rare, in the context of spontaneous OHSS and abdominal pain, ovarian complications such as follicular rupture, cyst hemorrhage, or ovarian torsion should always be considered.
Introduction Ovarian hyperstimulation syndrome (OHSS) is extremely rare in spontaneous pregnancies. Spontaneous OHSS can result from glycoprotein hormones stimulating follicle-stimulating hormone receptors (FSHR). Presentation of case We report a twin pregnancy in which ovarian torsion and hemoperitoneum complicating OHSS were treated with left adnexectomy and aspiration. The only trigger for spontaneous OHSS in this case was high levels of chorionic gonadotropin hormone. Discussion Multiple pregnancy, gestational trophoblastic disease, primary hypothyroidism, thyroid-stimulating hormone/gonadotropin-secreting adenomas, and mutations of the FSHR gene may trigger spontaneous OHSS. Conclusion Spontaneous OHSS should be included in the differential diagnosis of acute abdomen in pregnant women; if spontaneous OHSS is diagnosed, the etiology should be determined in order to focus the treatment and avoid future complications.
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Affiliation(s)
- Núria Gil Navarro
- Department of Obstetrics and Gynecology, Corporació Sanitària Parc Taulí, Parc Tauli, 1, 08208 Sabadell, Spain.
| | - Emma Garcia Grau
- Department of Obstetrics and Gynecology, Corporació Sanitària Parc Taulí, Parc Tauli, 1, 08208 Sabadell, Spain
| | - Sílvia Pina Pérez
- Department of Obstetrics and Gynecology, Corporació Sanitària Parc Taulí, Parc Tauli, 1, 08208 Sabadell, Spain
| | - Laia Ribot Luna
- Department of Obstetrics and Gynecology, Corporació Sanitària Parc Taulí, Parc Tauli, 1, 08208 Sabadell, Spain
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Abstract
Ovarian hyper-stimulation syndrome (OHSS) is an uncommon identity due to variable number of causes, gestation and gestational disease being more common than thyroiditis and other causes. The role of radiology and biochemical markers are of utmost importance in not only diagnosing spontaneous ovarian hyper-stimulation syndrome (sOHSS) but also ruling out other cystic ovarian diseases and to determine the underlying aetiology and course of the disease. Understanding its pathophysiology and genetics holds the key to unravel the mysteries of this condition.
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Affiliation(s)
| | | | - Kartik Mittal
- b Department of Radiology , Seth GS Medical College and KEM Hospital , Mumbai , Maharashtra , India
| | - Sunita Kale
- b Department of Radiology , Seth GS Medical College and KEM Hospital , Mumbai , Maharashtra , India
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