A 27 years old primigravida, with no significant past medical history, was referred to Endocrine clinic at 37 weeks gestation with hirsutism. She developed hirsute features during pregnancy and symptoms progressed with advancing gestation. Her physical examination revealed thick coarse dark hair growth in the midline of lower abdomen, between the breasts and forearms. She noted deepening of her voice but denied headaches, visual disturbance or clitromegaly.
A hormonal profile at 37 weeks gestation showed very high serum testosterone level at 37.9 nmol/L, raised androstenedione >35 nmol/L with normal DHEAS at 1.6 μmol/L and suppressed FSH and LH at
The hormonal profile returned back to normal with normal testosterone and androstenedione after delivery and has remained normal on repeating the hormones. The female baby did not showed any evidence of virilisation.
The patient represents a very rare condition of high testosterone in pregnancy returning back to normal following delivery and there are a few cases in the literature. This condition most frequently arises in the third trimester, virilisation of the mother occurs in a third of cases. Virilisation of the foetus has not been reported. The exact pathological mechanism of this condition is not known, differential diagnoses include pregnancy luteoma and Theca-lutein cysts. As our patient was primigravida, caucasian and had polycystic ovaries, the likely diagnosis is Theca-lutein cysts.