Spontaneous ovarian hyperstimulation syndrome in a nonpregnant female patient: a case report and literature review

Recurrent spontaneous ovarian hyperstimulation in a young nonpregnant Chinese woman with Rathke cleft cyst and a KISS1R variant: A rare case report and literature review

Unexplained spontaneous ovarian hyperstimulation syndrome (sOHSS) in a nonpregnant young woman is rare, with fewer than five cases documented in the literature. Although four distinct causative types of sOHSS have been identified, some cases remain beyond the scope of our current understanding. A young Chinese woman with sOHSS presented on multiple occasions with sOHSS between the ages of 18.6 and 20.6 years, with acute abdominal discomfort, ascites, hemoconcentration, and pronounced ovarian enlargement coinciding with minor ovulatory anomalies. During the most recent episode, concern regarding a malignant ovarian neoplasm led to emergent unilateral salpingo-oophorectomy. Remarkably, her menstrual cycle normalized after surgery, with no subsequent recurrence of sOHSS. Subsequent diagnostic evaluations identified a Rathke cleft cyst (RCC) in the pituitary gland and a heterozygous mutation in the KISS1R gene. Neither of these findings corresponded with any of the four informally recognized causes of sOHSS, suggesting a hitherto unrecognized pathology. RCCs may cause OHSS by disrupting the endocrine system, while interactions between the kisspeptin system and estradiol may reach a critical threshold, culminating in sOHSS. This case provides important insights into sOHSS and will hopefully spearhead further research into pituitary anomalies and the intricacies of the kisspeptin system. Clinicians are urged to maintain a high level of vigilance for similar presentations and ensure timely and tailored therapeutic interventions.

Spontaneous ovarian hyperstimulation syndrome mimicking ovarian cancer in a nonpregnant woman: A case report and literature review

Spontaneous ovarian hyperstimulation syndrome is an extremely rare condition, especially in nonpregnant women who do not exhibit exogenous ovarian stimulation. Herein, we present a case of spontaneous ovarian hyperstimulation syndrome in a 28-year-old nonpregnant woman who presented with life-threatening multiorgan dysfunction. Initial imaging studies and tumor marker assessment suggested the presence of a malignant ovarian tumor, posing substantial diagnostic challenges. The patient underwent emergency surgery due to severe hemorrhagic shock. Intraoperative findings revealed irregular and deformed ovaries; however, histologic examination showed luteinizing hemorrhagic cysts, leading to a diagnosis of spontaneous ovarian hyperstimulation syndrome. This case highlights the importance of considering spontaneous ovarian hyperstimulation syndrome in the differential diagnosis of ovarian enlargement with ascites, even in the absence of pregnancy or ovarian stimulation. It also underscores the critical role of expert radiological interpretation in such complex cases.

Fertility Preservation and Ovarian Hyperstimulation Syndrome Management in Cancer Care: A Pathophysiological Perspective on Gonadotropin-Releasing Hormone Agonists and Antagonists

This narrative review delves into the evolving landscape of fertility preservation techniques, with a particular focus on their use in patients undergoing oncology treatment that carries a risk of ovarian insufficiency. Advances in established methods such as cryopreservation of oocytes and embryos are highlighted, and the increasing use of gonadotropin-releasing hormone (GnRH) agonists is discussed. The review also addresses the complexities and controversies associated with these approaches, such as the 'flare-up' effect associated with GnRH agonists and the potential of GnRH antagonists to reduce the risk of ovarian hyperstimulation syndrome. Despite advances in fertility preservation, the report highlights the challenges we face, including the need for personalized treatment protocols and the management of associated risks. It calls for continued research and collaboration between healthcare professionals to refine these techniques and ultimately improve reproductive outcomes for patients facing the prospect of fertility-impairing treatment.

Spontaneous ovarian hyperstimulation syndrome in a pregnant woman with hypothyroidism: a case report

Objective

To study a rare case of spontaneous ovarian hyperstimulation syndrome in a naturally conceived pregnancy associated with overt hypothyroidism.

Design

Case report.

Setting

Endocrinology private practice.

Patient(s)

A 32-year-old woman who was 13 weeks pregnant with bilaterally enlarged ovaries presumed to be secondary to hypothyroidism.

Intervention(s)

Administration of levothyroxine and titration of the dose.

Main Outcome Measure(s)

Regression of signs and symptoms of spontaneous ovarian hyperstimulation syndrome after 12 weeks of therapy.

Result(s)

The patient was diagnosed with severe hypothyroidism, as confirmed by her elevated thyroid-stimulating hormone level. Ultrasound evaluation revealed ovarian enlargement secondary to multiple contiguous cysts with anechoic content. The patient was administered levothyroxine 175 μg/day. Results of hormonal studies demonstrated thyroid function normality at week 12 after treatment. Incomplete regression of ovarian cysts was also noticed within this period. At week 37, the patient developed preeclampsia, and cesarean delivery was recommended. An 8-month postpartum ultrasound evaluation revealed complete regression of the cysts.

Conclusion(s)

Spontaneous ovarian hyperstimulation syndrome secondary to hypothyroidism may be the cause of ovarian enlargement, and levothyroxine replacement seems an appropriate primary therapeutic option. Proper endocrinological assessment of patients is recommended as it may avoid unfavorable outcomes.

High ovarian GDF-8 levels contribute to elevated estradiol production in ovarian hyperstimulation syndrome by stimulating aromatase expression

Rationale: Growth differentiation factor-8 (GDF-8), also known as myostatin, belongs to the transforming growth factor-beta (TGF-β) superfamily. GDF-8 is expressed in the ovary and regulates various ovarian functions. Ovarian hyperstimulation syndrome (OHSS) is one of the most serious disorders during in vitro fertilization treatment. Aromatase, encoded by the CYP19A1 gene, is the enzyme that catalyzes the final step in estradiol (E2) biosynthesis. It has been demonstrated that high serum E2 levels are associated with the development of OHSS. However, the effects of GDF-8 on aromatase expression and its roles in the pathogenesis of OHSS remain unclear. Methods: The effect of GDF-8 on aromatase expression and the underlying mechanisms were explored by a series of in vitro experiments in primary human granulosa-lutein (hGL) and KGN cells. Rat OHSS model and human follicular fluid samples were used to examine the roles of the GDF-8 system in the pathogenesis of OHSS. Results: We demonstrate that GDF-8 stimulates aromatase expression and E2 production in hGL and KGN cells. In addition, TGF-β type I receptor ALK5-mediated SMAD2/3 signaling is required for GDF-8-induced aromatase expression and E2 production. Using a rat OHSS model, we show that the aromatase and GDF-8 levels are upregulated in the ovaries of OHSS rats. Blocking the function of ALK5 by the administration of its inhibitor, SB431542, alleviates OHSS symptoms and the upregulation of aromatase. Clinical results reveal that the protein levels of GDF-8 are upregulated in the follicular fluid of OHSS patients. Moreover, the expression of GDF-8 is increased in hGL cells of OHSS patients. Conclusions: This study helps to elucidate the mechanisms mediating the expression of aromatase in human granulosa cells, which may lead to the development of alternative therapeutic approaches for OHSS.