Introduction: A 28-year-old primigravida developed increasing hairgrowth in androgen sensitive areas in the first trimester of her first pregnancy. She was previously well with menarche at 14 years, normal periods thereafter and no difficulty in conceiving. She took no medication. Clinically, at 34 weeks gestation she had significant hirsutism of her face, arms, legs and a prominent male escutcheon. She was obese but not Cushingoid.
Investigations and results:
|34/52 gestation||36/52 gestation||4 days postpartum||11 days postpartum|
|UFC||35 nmol/24 h||342|
Urinary androstenedione metabolites, androsterone (4000) and aetiocholanolone (3000) were significantly elevated compared to pregnant women of a similar gestational age (<1000 μg/g creatinine), and investigations for CAH were normal. MRI scans of the abdomen and pelvis revealed a normal female foetus, normal adrenal glands but her ovaries were not visible. A postpartum transvaginal ultrasound scan revealed polycystic ovaries but no tumour.
She delivered a healthy, normal female child and her hyperandrogenism (Table 1) and hirsutism resolved completely postpartum.
Discussion: Although pregnancy is a pseudocushingoid state, symptomatic hyperandorgenism occurs only rarely. In hyperandrogenic states, the foetus is protected from virilization by several mechanisms. The cause for hirsutism in our patient was clearly reversible in the postpartum period and suggested a benign pregnancy specific source. Although a luteoma of pregnancy or hyperreactio luteinalis (both of which regress after delivery) were possibile diagnoses, she was a Caucasian and these usually large tumours were not visible at MRI scanning. The appearances of the ovaries postpartum on ultrasound scanning indicates PCOS (unlikely) or the hyperandorgenism during pregnancy.