Gynecology and Reproductive Endocrinology

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Case Report - Gynecology and Reproductive Endocrinology (2020) Volume 4, Issue 2

Partial hydatidiform mole with spontaneous ovarian hyperstimulation syndrome.

 

Article type: Case Report

ISSN: 2591-7994

HomePageURL: https://www.alliedacademies.org/gynecology-reproductive-endocrinology/

Accepted on: June 01, 2020

Journal short name: Gynecol Reproduct Endocrinol

Volume: 04                                                                                                                                                

Issue: 02

Citation: Sousa I, Sampaio A, Sampaio J, et al. Partial hydatidiform mole with spontaneous ovarian hyperstimulation syndrome. Gynecol Reproduct Endocrinol. 2020;4 (2):1-5.

Partial hydatidiform mole with spontaneous ovarian hyperstimulation syndrome.

Isabel Sousa1*, André Sampaio2, Joana Sampaio2, Rui Mendonça2, Tiago Rocha3, Carlos Ponte2, Rui César1

1Serviço de Endocrinologia e Nutrição do Hospital do Divino Espírito Santo-Epe (HDES-EPE), Ponta Delgada, Portugal

2Serviço de Ginecologia e Obstetrícia do HDES-EPE, Ponta Delgada, Portugal

3Ex-Assistente Graduado Endocrinologia e Nutrição da Maternidade Dr. Alfredo da Costa, Lisboa, Ponta Delgada, Portugal

Abstract

The authors present an atypical case of partial hydatidiform mole (PHM). Woman, 36 years old, who went to the emergency room for abdominal pain associated with eleven-week pregnancy. Echography revealed the presence of hyper stimulated ovaries leading to diagnosis of spontaneous Ovarian Hyperstimulation Syndrome (OHSS). Blood sample revealed high levels of hCG (1422000 U/L), which associated with the ultrasound finding of placenta with vesicular areas, led to the suspicion of PHM. With this suspicion and the high value of nuchal translucency, amniocentesis was performed, confirming the diagnosis of PHM – 69, XXX. The pregnant, with history of hypothyroidism, presented analytic hyperthyroidism which is rare in this clinical situation. The medical termination of pregnancy resolved this pathologic situation and also hyperthyroidism condition. Hydatidiform mole, with increased levels of hCG, is one of the three possible mechanisms for spontaneous OHSS.

Keywords: Hydatidiform mole, Partial hydatidiform mole, Ovarian hyperstimulation, Chorionic gonadotropin, Thyrotrophic hormone (TSH).


Introduction

Hydatidiform Mole (HM) belongs to the group of medical conditions classified as Gestational Trophoblast Disease (GTD). This clinical entity is a proliferative disorder of placenta and it can locally invade the uterus or originate distant metastasis [1].

HM can be classified in two distinct entities – Complete HM (CHM) and Partial HM (PHM). HM always occurs after an aberrant fertilization. PHM is composed by a triploidy (69, XXY; 69, XYY; or 69, XXX) where the extra chromosomes have paternal origin. Molar gestations are originated at villus trophoblast and they are characterized by villous hydrops and trophoblastic hyperplasia due to hyper expression of paternal genes. PHM has lower levels of human chorionic gonadotropin hormone (hCG) than CHM and, for that reason it is less common associated with sequels of stimulation by hCG [2]. The normal or pathologic trophoblast produces hCG [3]. hCG is a glycoprotein composed by 2 subunits, α and β, connected by non-covalent form [4]. Subunit β of GCH and TSH have great homology and, for that reason, hCG can also have thyrotrophic activity. However, this activity is much weaker than TSH activity [5].

Case Report

A 36-year-old woman, Caucasian, G2P1 (eutocic delivery, newborn with 4040 g), went to Emergency room with abdominal pain that started 2 weeks ago. She also complained of abdominal distension and light polypnea. She denied oliguria or dyspnea. At the observation, she had a bulky abdomen, with painful palpation and guarding. Pelvic ultrasound showed an evolutive pregnancy, spontaneous, with 11 weeks and 4 days. Fetus’ vital signs and amniotic fluid were normal. Ovaries were visualized and described as bulky (Figures 1 and 2). Patient was admitted with diagnosis of Spontaneous Ovarian Hyperstimulation Syndrome (OHSS). Patient had history of Gestational Hypertension on her first pregnancy and subclinical hypothyroidism controlled with levothyroxine sodium 25 mg id. She was allergic to penicillin and her blood group was 0 Rh+.

On endocrinologic observation, patient was clinically euthyroid, without compressive complains. She denied exophthalmia, diarrhea, sweating, weight loss (weight: 72 kg), tremor or pretibial edema, heart rate of 84 bpm and blood pressure 120/60 mmHg. She mentioned to have taken iodized salt. Physical examination showed a palpable thyroid with elastic consistence, painless, mobile and without adenopathies.

Gynecology and Reproductive Endocrinology

Abstract

 

The authors present an atypical case of partial hydatidiform mole (PHM). Woman, 36 years old, who went to the emergency room for abdominal pain associated with eleven-week pregnancy. Echography revealed the presence of hyper stimulated ovaries leading to diagnosis of spontaneous Ovarian Hyperstimulation Syndrome (OHSS). Blood sample revealed high levels of hCG (1422000 U/L), which associated with the ultrasound finding of placenta with vesicular areas, led to the suspicion of PHM. With this suspicion and the high value of nuchal translucency, amniocentesis was performed, confirming the diagnosis of PHM – 69, XXX. The pregnant, with history of hypothyroidism, presented analytic hyperthyroidism which is rare in this clinical situation. The medical termination of pregnancy resolved this pathologic situation and also hyperthyroidism condition. Hydatidiform mole, with increased levels of hCG, is one of the three possible mechanisms for spontaneous OHSS.