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Potentially life-threatening emergency
Ovarian hyperstimulation syndrome
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Ovarian hyperstimulation syndrome

Contributors: Mitchell Linder MD
Other Resources UpToDate PubMed

Synopsis

Ovarian hyperstimulation syndrome (OHSS) is a condition in which the ovaries become large, swollen, and often painful. The most common cause is as a complication of fertility drugs used to stimulate multiple follicle growth. Rare cases can occur spontaneously without any prior medical interventions.

OHSS is caused by increased follicle growth in conjunction with high levels of estradiol. The exact pathophysiology is unknown but is thought to be related to increased vascular permeability of the ovarian tissues leading to fluid leaking into the abdomen and causing symptomatology. Large fluid shifts can lead to hypovolemic hyponatremia.

Patients may present with abdominal pain, nausea, vomiting, ascites, edema, dyspnea, electrolyte imbalances, and/or hypotension.

Symptoms depend on the degree of severity:

Mild cases occur when patients have some abdominal distention and pain. They often will have swelling, nausea, and vomiting as well. Ovarian size is usually smaller than 8 cm. This is thought to occur in up to 10% of patients.

Moderate cases have the same symptoms as mild cases plus ascites demonstrated on imaging studies.

Severe cases occur in about 1% of patients. Patients can have significant ascites as well as pleural effusions / respiratory distress, oliguria, electrolyte changes, thrombosis, and hemoconcentration. Ovarian size is usually larger than 12 cm.

Critical cases are rare but can be life-threatening, including arrythmia, thromboembolism, hydrothorax, pulmonary embolism, pericardial effusion, adult respiratory distress syndrome, renal failure, and/or sepsis.

Risk factors include ovarian stimulation undertaken at a young age, a history of prior OHSS, elevated antimullerian hormone levels, and a history of polycystic ovarian syndrome.

Codes

ICD10CM:
N98.1 – Hyperstimulation of ovaries

SNOMEDCT:
129635004 – Ovarian hyperstimulation syndrome

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:02/09/2020
Last Updated:03/18/2020
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Potentially life-threatening emergency
Ovarian hyperstimulation syndrome
A medical illustration showing key findings of Ovarian hyperstimulation syndrome (Moderate) : Diarrhea, Nausea, Abdominal distension, Ascites, Anasarca, Weight gain
Copyright © 2022 VisualDx®. All rights reserved.