Endocrine Abstracts

A nineteen-year-old primiparous lady was admitted in her 40th week of gestation with irregular painful contractions. Following a prolonged labour (approx. eighteen hours) she underwent an emergency caesarean section because of decelerations in the foetal heartbeat and meconium staining of her liquor. At a vaginal examination performed pre caesarean to assess the state of her cervix, her clitoris was noted to be enlarged. She delivered a healthy girl who was not virilised. Before delivery a serum sample was sent to measure androgen levels. Her serum testosterone was > 52 nmol/L (0.5-3.0), 17 hydroxy- progesterone 88.9 nmol/L (2.0-12.0), DHEA Sulphate 2.8 μmol/L (< 11.6). At caesarean no undue comments were made about the external appearance of her ovaries was made.
An ultrasound scan of her ovaries carried out 3 days post partum showed bilaterally enlarged ovaries which contained multiple small cyst distributed both peripherally and centrally.
She had been normotensive throughout her pregnancy, her blood pressure measured 115/75 mmHg on admission. When questioned in retrospect, she admitted to noticing an increase in facial and upper thigh hair at about her twentieth week of gestation.
Post partum her testosterone returned to normal (2.1 nmol/L) imaging and dynamic testing to exclude androgen production from her adrenals was normal.
Androgenisation during pregnancy is rare and raises anxiety about maternal and feotal well being. We discuss the likely diagnosis, and mechanisms underlying virilisation occurring during pregnancy.