1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Kusuma Boddu S, Ayyavoo A, Hebbal Nagarajappa V, Kalenahalli KV, Muruda S, Palany R. Van Wyk Grumbach Syndrome and Ovarian Hyperstimulation in Juvenile Primary Hypothyroidism: Lessons From a 30-Case Cohort. J Endocr Soc 2023; 7:bvad042. [PMID: 37197410 PMCID: PMC10184442 DOI: 10.1210/jendso/bvad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Indexed: 05/19/2023] Open
Abstract
Context Prolonged hypothyroidism in children commonly causes short stature with delayed bone maturation, and delayed puberty. However, a paradoxical occurrence of peripheral precocious puberty and pituitary enlargement in chronically untreated juvenile hypothyroidism was first reported by Van Wyk and Grumbach in 1960. Objective To create increased awareness and a better understanding of this clinical entity among emergency room physicians, pediatricians, surgeons, gynecologists and oncologists. Methods Case records of children diagnosed with Van Wyk-Grumbach syndrome (VWGS) were analyzed retrospectively. Results Twenty-six girls and 4 boys were identified (2005-2020). All had profound primary hypothyroidism (total thyroxine [T4]: 2.5-33.5 nmol/L, thyrotropin: > 75-3744 μIU/mL). Hypothyroidism was not the referral diagnosis in any of the girls. Among them, 17 were referred for precocious puberty, 5 with a diagnosis of pituitary tumor on magnetic resonance imaging, and others for acute surgical abdomen in 7 girls (painful abdominal mass-2, ovarian tumor-2, ovarian torsion-2, ruptured ovarian cyst-1), acute myelopathy in 1, and menorrhagia with headache in another. All girls were successfully managed with levothyroxine replacement alone, except for the 2 with ovarian torsion, who required surgery. Menstruation ceased promptly with T4 therapy in all girls, occurring at an age-appropriate later date. All boys had testicular enlargement at presentation that regressed partially after T4 treatment. Catch-up growth was remarkable during the first treatment year, but the final height was compromised in all. Conclusion Increased awareness of varied presentations of VWGS is vital among pediatricians to facilitate early diagnosis and targeted investigations, and to help in the initiation of the simple yet highly rewarding T4 replacement therapy to avoid all possible complications.
Collapse
Affiliation(s)
- Sirisha Kusuma Boddu
- Pediatric & Adolescent Endocrinology, Rainbow Children's Hospital, Hyderabad 5000814, India
| | - Ahila Ayyavoo
- Pediatric and Adolescent Endocrinology, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore 641037, India
| | - Vani Hebbal Nagarajappa
- Pediatric and Adolescent Endocrinology, Indira Gandhi Institute of Child Health, Bangalore 560029, India
| | | | - Shantakumar Muruda
- Clinical Biochemistry, Sagar Hospital, Jayanagar, Bangalore 560041, India
| | - Raghupathy Palany
- Correspondence: Raghupathy Palany, MBBS, DCH, MD, FRCP, Sagar Hospitals, Nos. 44-54, 30th Cross Rd, 4th T Block E, Tilak Nagar, Jayanagar, Bangalore, Karnataka 560041, India.
| |
Collapse
|
3
|
Assirelli V, Baronio F, Ortolano R, Maltoni G, Zucchini S, Di Natale V, Cassio A. Transient central precocious puberty: a new entity among the spectrum of precocious puberty? Ital J Pediatr 2021; 47:210. [PMID: 34688301 PMCID: PMC8542285 DOI: 10.1186/s13052-021-01163-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/28/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Recently, we observed some cases of Precocious Puberty (PP) with a partial central activation of hypothalamic-pituitary-gonadal (HPG) axis that tended to normalized in 6–12 months. To evaluate the frequency of this form within the spectrum of forms of PP, we retrospectively assessed the clinical, hormonal and ultrasound characteristics of patients attending to our Center for signs of PP, between 2007 and 2017. To hypothesize some causes of this “pubertal poussée” a questionnaire about environmental data was provided to patients. Methods 96 girls were recruited for the study and divided into three Groups. Group 1: 56 subjects with Central PP (CPP) requiring treatment with GnRH analogue; Group 2: 22 subjects with transient activation of pubertal axis, that tended to normalize, “Transient CPP”(T-CPP); Group 3: 18 subjects with Isolated Thelarche (IT). Results Mean age at diagnosis was 6.8 ± 1.0 years in Group 1, 5.9 ± 1.3 years in Group 2 and 5.6 ± 1.5 years in Group 3. A significant increase of diagnosis of T-CPP was observed over the study period. Significantly higher use of some homeopathic medicines and potential exposure to pesticides was reported in Group 2 vs Group 1. Conclusions To our knowledge, we first reported a form defined as T-CPP, characterized by partial activation in the HPG axis normalizing over time. An increased use of homeopathic medicines and exposure to environmental pollutants in these patients was evidenced.
Collapse
Affiliation(s)
- Valentina Assirelli
- Program of Endocrine-Metabolic Diseases, Unit of Pediatrics, University of Bologna, IRCCS- University Hospital of Bologna, Via Massarenti 11, Bologna, Italy.,Specialty School of Paediatrics - Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Federico Baronio
- Program of Endocrine-Metabolic Diseases, Unit of Pediatrics, University of Bologna, IRCCS- University Hospital of Bologna, Via Massarenti 11, Bologna, Italy
| | - Rita Ortolano
- Program of Endocrine-Metabolic Diseases, Unit of Pediatrics, University of Bologna, IRCCS- University Hospital of Bologna, Via Massarenti 11, Bologna, Italy
| | - Giulio Maltoni
- Program of Endocrine-Metabolic Diseases, Unit of Pediatrics, University of Bologna, IRCCS- University Hospital of Bologna, Via Massarenti 11, Bologna, Italy
| | - Stefano Zucchini
- Program of Endocrine-Metabolic Diseases, Unit of Pediatrics, University of Bologna, IRCCS- University Hospital of Bologna, Via Massarenti 11, Bologna, Italy
| | - Valeria Di Natale
- Program of Endocrine-Metabolic Diseases, Unit of Pediatrics, University of Bologna, IRCCS- University Hospital of Bologna, Via Massarenti 11, Bologna, Italy
| | - Alessandra Cassio
- Program of Endocrine-Metabolic Diseases, Unit of Pediatrics, University of Bologna, IRCCS- University Hospital of Bologna, Via Massarenti 11, Bologna, Italy.
| |
Collapse
|
4
|
|
5
|
Mittal K, Koticha R, Dey AK, Anandpara K, Agrawal R, Sarvothaman MP, Thakkar H. Radiological illustration of spontaneous ovarian hyperstimulation syndrome. Pol J Radiol 2015; 80:217-27. [PMID: 25960820 PMCID: PMC4418209 DOI: 10.12659/pjr.893536] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/26/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The role of radiology is of utmost importance not only in diagnosing s-OHSS but also in ruling out other cystic ovarian diseases and to determine the underlying etiology and course of the disease. We presented a radiological algorithm for diagnosing the various causes of s-OHSS. CASE REPORT A 26-year-old female, gravida one was referred to radiology department with history of lower abdominal pain, nausea and vomiting since 2 days which was gradual in onset and progression. The patient had no significant medical and surgical history. CONCLUSIONS This article illustrates and emphasizes that diagnosis of s-OHSS and its etiology can be completely evaluated radiologically. Biochemical markers will confirm the radiological diagnosis.
Collapse
Affiliation(s)
- Kartik Mittal
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Raj Koticha
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Amit K Dey
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Karan Anandpara
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Rajat Agrawal
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Madhva P Sarvothaman
- Department of Obstetrics and Gynaecology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Hemangini Thakkar
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| |
Collapse
|
6
|
Singh A, Singh K, Khandelwal RG, Choudhary P, Sharma VK. Spontaneous Severe Ovarian Hyper Stimulation Syndrome Associated with Massive Pericardial Effusion and Hypothyroidism in Non-pregnant Woman. J Obstet Gynaecol India 2014; 65:132-5. [PMID: 25883447 DOI: 10.1007/s13224-014-0621-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/16/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Amit Singh
- Department of Surgery, J. L. N. Medical College, Ajmer, 305001 India
| | - Kumkum Singh
- Department of Surgery, J. L. N. Medical College, Ajmer, 305001 India
| | | | - Prakash Choudhary
- Department of Surgery, J. L. N. Medical College, Ajmer, 305001 India
| | | |
Collapse
|
7
|
Langroudi RM, Amlashi FG, Emami MHH. Ovarian cyst regression with levothyroxine in ovarian hyperstimulation syndrome associated with hypothyroidism. Endocrinol Diabetes Metab Case Rep 2013; 2013:130006. [PMID: 24616758 PMCID: PMC3922305 DOI: 10.1530/edm-13-0006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/15/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Spontaneous ovarian hyperstimulation syndrome (sOHSS) can occur following hypothyroidism. Ultrasonography facilitates diagnosis and monitoring of this syndrome. We describe ovarian sonographic changes in a hypothyroid patient with sOHSS after treatment with levothyroxine (l-T4). CASE PRESENTATION A 15-year-old girl presented with abdominal pain and distension for a few months. On examination, she had classical features of hypothyroidism. Abdominal and pelvic ultrasound revealed enlarged ovaries with multiple thin-walled cysts and mild ascitic fluid. On follow-up, abdominal ultrasound showed significant reduction of ovary size after 6 weeks of initiation of l-T4. Normal ovary size with complete regression of ovarian cysts was seen after 4 months. CONCLUSION Serial ultrasound in sOHSS associated with hypothyroidism showed regression of ovarian cysts and ovarian volume after 4 months whereas in other studies, it is reported to happen in various durations, presumably according to its etiology. LEARNING POINTS OHSS can rarely occur due to hypothyroidism.This type of OHSS can be simply treated by l-T4 replacement, rather than conservative management or surgery in severe cases.Ultrasound follow-up shows significant regression of ovarian size and cysts within 6 weeks of initiation of l-T4.Ultrasound follow-up shows normal ovarian size with complete resolution of ovarian cysts 4 months after treatment.
Collapse
|
8
|
Kanza RE, Gagnon S, Villeneuve H, Laverdiere D, Rousseau I, Bordeleau E, Berube M. Spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma associated with primary hypothyroidism. World J Radiol 2013; 5:20-4. [PMID: 23494012 PMCID: PMC3596565 DOI: 10.4329/wjr.v5.i1.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 08/21/2012] [Accepted: 08/28/2012] [Indexed: 02/06/2023] Open
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 life-threatening complications, and unnecessary surgery.
Collapse
|
9
|
Baranowski E, Högler W. An unusual presentation of acquired hypothyroidism: the Van Wyk-Grumbach syndrome. Eur J Endocrinol 2012; 166:537-42. [PMID: 22170796 DOI: 10.1530/eje-11-0494] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The association in young females of long-standing primary hypothyroidism, isosexual precocious pseudopuberty and multicystic enlarged ovaries was first described in 1960 by Van Wyk and Grumbach. Since then, sporadic case reports have contributed to clarifying the key features of this syndrome. The unique elements that lead to this diagnosis are FSH-dominated sexual precocity combined with a delayed bone age in the presence of hypothyroidism. It is important to recognise this syndrome because initiating simple thyroid hormone replacement completely resolves symptoms and hormone abnormalities, avoiding unnecessary investigations for malignancies or surgical intervention. We describe an 8-year-old girl with autoimmune thyroiditis and severe long-standing hypothyroidism presenting with the clinical features of Van Wyk-Grumbach syndrome, a secondary TSH-secreting adenoma and hyperprolactinaemia. In addition, this girl presented with microcytic anaemia, elevated erythrocyte sedimentation rate (ESR) and two unusual features - a newly developed streaky hyperpigmented skin lesion and parathyroid hormone suppression despite vitamin D deficiency. Thyroxine replacement normalised all hormone abnormalities and shrunk the pituitary adenoma within 9 months, but the new skin lesion persisted. We review the literature and explore the pathophysiology of known and new features that give rise to speculation indicating stimulation of the FSH G protein-coupled receptor by excessive TSH, but LH suppression by hyperprolactinaemia.
Collapse
Affiliation(s)
- E Baranowski
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK.
| | | |
Collapse
|
10
|
Rahbour G, Ullah MR, Yassin N, Thomas GP. Cullen's sign - Case report with a review of the literature. Int J Surg Case Rep 2012; 3:143-6. [PMID: 22365919 DOI: 10.1016/j.ijscr.2012.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 01/07/2012] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Cullen's sign is described as superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region. It is also known as peri-umbilical ecchymosis. PRESENTATION OF CASE We report a case of a fifty-three year old gentleman who presented with non-specific abdominal pain. Significant bruising was present within the subcutaneous fatty tissue on the anterior abdominal wall in keeping with 'Cullen's sign.' Of note he denied any alcohol intake and his amylase was normal. A diagnosis of pancreatitis was made following a CT scan of his abdomen. DISCUSSION A search of the entire English literature using PubMed with the phrase 'Cullen's sign' has been performed. Papers were reviewed in relation to recognition of this clinical sign, differential diagnosis, and management. CONCLUSION Our case and review of the literature highlights the rarity of this clinical sign which a clinician may encounter. In addition we draw to attention the importance of having knowledge of the underlying possible conditions which may lead to this sign, and can be vital in successful acute management.
Collapse
Affiliation(s)
- Goher Rahbour
- St. Mark's Hospital and Academic Institute, Harrow, London HA1 3UJ, United Kingdom
| | | | | | | |
Collapse
|
11
|
Panico A, Lupoli GA, Fonderico F, Colarusso S, Marciello F, Poggiano MR, Del Prete M, Magliulo R, Iervolino P, Lupoli G. Multiple ovarian cysts in a young girl with severe hypothyroidism. Thyroid 2007; 17:1289-93. [PMID: 18020917 DOI: 10.1089/thy.2007.0056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Case study of a young female patient with severe hypothyroidism due to autoimmune thyroiditis and multiple ovarian cysts is reported. A 14-year 7-month-old girl presented with pelvic and abdominal pain and severe asthenia. Her last menstrual period was 10 months before presentation. Physical examination showed obesity; apathetic and flat expression; periorbital puffiness; pale, cold, dry skin and slow sustained reflexes; swelling in the hands and feet; no galactorrhea; a hardly palpable thyroid gland; and ovaries with a palpable irregular surface. Her heart rate was 90 bpm with a blood pressure within the normal range (110/70 mmHg). Laboratory findings showed severe hypothyroidism (thyroid-stimulating hormone [TSH]: 960 mIU/L), gravis macrocytic anemia, hyperfibrinogenemia, and hyperprolactinemia. Imaging examinations revealed a normal-size thyroid with irregular echogenicity, strongly hypoechogenous area at the neck ultrasonography, bilateral multilocular ovarian masses with cystic components at pelvic ultrasound and computed tomography, and both anterior and posterior pericardial effusion at echocardiography. As soon as thyroid replacement therapy was initiated, all symptoms progressively disappeared and biochemical and hormonal values normalized, while the right ovary did not decrease in size during the follow-up period. For this reason, our patient underwent right ovarian wedge resection 14 months after the initiation of medication replacement. Ovarian histological examination showed a benign ovarian cyst with extensive hemorrhage and myxedematous infiltration. It is concluded that it is important to recognize early in young girls the association between large multiple ovarian cysts and high elevated levels of TSH in order to resolve this disorder with substitutive therapy.
Collapse
Affiliation(s)
- Annalisa Panico
- Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica, Università degli Studi Federico II, Napoli, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|