Hemolysis, Elevated Liver Enzyme Levels, and Low Platelet Levels (HELLP) Syndrome in Spontaneous Singleton Pregnancy Complicated by Hyperreactio Luteinalis: A Case Report

Document Type : Case Report

Authors

1 Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Gynecologist, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Resident, Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Health Center No. 2, Isfahan Province Health enter, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Hyperreactio Luteinalis (HL) is a rare condition during spontaneous pregnancy characterized by bilaterally, or in rare cases, unilaterally enlarged ovaries containing multiple self-limited theca lutein cysts, usually associated with high maternal serum levels of human chorionic gonadotropin (HCG) and hyperandrogenic state. Most of the patients require surgical intervention during their pregnancy because of ovarian torsion, preeclampsia, syndrome of hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP), or to rule out ovarian malignancy. However, we can avoid unnecessary surgical intervention with accurate diagnosis of HL by means of laboratory tests and magnetic resonance imaging (MRI).Case Report: A 27-year-old pregnant woman with gestational age of 27 weeks was admitted with labor pain and complicated with HELLP syndrome. In ultrasonography, bilateral and multiple ovarian cysts were seen.Conclusion: Reviewing this case suggests a relationship between HL and HELLP syndrome and may help to explain the underlying causes of preeclampsia; HL may be a predictor of preeclampsia and HELLP syndrome in pregnancy.

Keywords

References

  1. Bradshaw KD, Santos-Ramos R, Rawlins SC, MacDonald PC, Parker CR, Jr. Endocrine studies in a pregnancy complicated by ovarian theca lutein cysts and hyperreactio luteinalis. Obstet Gynecol 1986; 67(3 Suppl): 66S-9S.
  2. Muechler EK, Fichter J, Zongrone J. Human chorionic gonadotropin, estriol, and testosterone changes in two pregnancies with hyperreactio luteinalis. Am J Obstet Gynecol 1987; 157(5): 1126-8.
  3. Takeda T, Minekawa R, Makino M, Sugiyama T, Murata Y, Suehara N. Hyperreactio luteinalis associated with severe twin-to-twin transfusion syndrome. Gynecol Obstet Invest 2002; 53(4): 243-6.
  4. Onodera N, Kishi I, Tamaoka Y, Yamazaki K, Kamei K. A case of recurrent hyperreactio luteinalis. Am J Obstet Gynecol 2008; 198(5): e9-10.
  5. Angioni S, Portoghese E, Milano F, Melis GB, Fulghesu AM. Hirsutism and hyperandrogenism associated with hyperreactio luteinalis in a singleton pregnancy: a case report. Gynecol Endocrinol 2007; 23(5): 248-51.
  6. Gatongi DK, Madhvi G, Tydeman G, Hasan A. A case of hyperreactio luteinalis presenting with eclampsia. J Obstet Gynaecol 2006; 26(5): 465-7.
  7. Bidus MA, Ries A, Magann EF, Martin JN. Markedly elevated beta-hCG levels in a normal singleton gestation with hyperreactio luteinalis. Obstet Gynecol 2002; 99(5 Pt 2): 958-61.
  8. Abe T, Ono S, Igarashi M, Akira S, Watanabe A, Takeshita T. Conservative management of hyperreactio luteinalis: a case report. J Nippon Med Sch 2011; 78(4): 241-5.
  9. Atis A, Cifci F, Aydin Y, Ozdemir G, Goker N. Hyperreactio luteinalis with preeclampsia. J Emerg Trauma Shock 2010; 3(3): 298.
  10. Simsek Y, Celen S, Ustun Y, Danisman N, Bayramoglu H. Severe preeclampsia and fetal virilization in a spontaneous singleton pregnancy complicated by hyperreactio luteinalis. Eur Rev Med Pharmacol Sci 2012; 16(1): 118-21.
  11. Grgic O, Radakovic B, Barisic D. Hyperreactio luteinalis could be a risk factor for development of HELLP syndrome: case report. Fertil Steril 2008; 90(5): 2008-6.
Journal of Isfahan Medical School
Volume 31, Issue 268 - Serial Number 268
November and December 2014
Pages 2250-2256

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History

  • Receive Date: 22 July 2013
  • Revise Date:
  • Accept Date: 06 April 2022

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