Ovarian torsion and spontaneous ovarian hyperstimulation syndrome in a twin pregnancy: A case report

Highlights

• 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.

Abstract

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.