Hyperreactio luteinalis: timely diagnosis minimizes the risk of oophorectomy and alerts clinicians to the associated risk of placental insufficiency

Hyperreactio luteinalis (HL) is a rare benign condition complicating pregnancy with multicystic bilateral ovarian enlargement, increased serum βhCG levels and spontaneous regression after delivery. HL has been associated with complications of pregnancy and the aim of our research was to review the literature, and add a new unpublished case from our group. We searched the internet-based medical databases for case reports and case series of hyperreactio luteinalis and we evaluated diagnostic path, treatment and outcome of pregnancies. We found 96 cases of HL from 1955 to 2013. HL was asymptomatic in 28% of cases but in 72% of patients there were symptoms like lower abdominal pain, nausea and vomiting, ascites and signs of virilization. Suspicion of malignancy was raised in 38% of cases. Surgical treatment of various types was performed in 48% of cases, with oophorectomy in 40% of this group. Several complications were associated with HL, in particular preeclampsia (PE) occurred in 24% of cases and fetal growth restriction (FGR) in 12%. Mean gestation at delivery was 35 weeks (range 25–42). Although preoperative diagnosis occurred in most cases, suspicion of malignancy was extensive, as was oophorectomy, demonstrating suboptimal understanding of the underlying physiopathology. We propose a diagnostic algorithm for this condition. Training of obstetricians in making the correct diagnosis may prevent unnecessary oophorectomies and may lead to early diagnosis and correct management of associated complications.