Severe Ovarian Hyperstimulation Syndrome in a Woman With Breast Cancer Under Letrozole Triggered With GnRH Agonist: A Case Report and Review of the Literature

Giuseppe Gabriele Iorio; Marika Ylenia Rovetto; Alessandro Conforti; Luigi Carbone; Roberta Vallone; Federica Cariati; Francesca Bagnulo; Raffaella Di Girolamo; Antonio La Marca; Carlo Alviggi

doi:10.3389/frph.2021.704153

Frontiers in Reproductive Health (Jul 2021)

Severe Ovarian Hyperstimulation Syndrome in a Woman With Breast Cancer Under Letrozole Triggered With GnRH Agonist: A Case Report and Review of the Literature

Giuseppe Gabriele Iorio,
Marika Ylenia Rovetto,
Alessandro Conforti,
Luigi Carbone,
Roberta Vallone,
Federica Cariati,
Francesca Bagnulo,
Raffaella Di Girolamo,
Antonio La Marca,
Carlo Alviggi

Affiliations

Giuseppe Gabriele Iorio: Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
Marika Ylenia Rovetto: Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
Alessandro Conforti: Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
Luigi Carbone: Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
Roberta Vallone: Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
Federica Cariati: Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
Francesca Bagnulo: Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
Raffaella Di Girolamo: Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
Antonio La Marca: Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
Carlo Alviggi: Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy

DOI: https://doi.org/10.3389/frph.2021.704153
Journal volume & issue: Vol. 3

Abstract

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We report a rare case of ovarian hyperstimulation syndrome (OHSS) in a 28-year-old woman with breast cancer and with a history of polycystic ovary syndrome (PCOS) despite treatment with letrozole and gonadotropin-releasing hormone agonist (GnRH-a) triggering in a GnRH antagonist (GnRH-ant) protocol without the administration of any human chorionic gonadotropin (hCG) for luteal-phase support. The patient, who underwent controlled ovarian syndrome (COS)-oocyte cryopreservation before chemotherapy, required hospitalization. Complete recovery was achieved after treatment with volume expanders, human albumin, and cabergoline. Based on our case and literature review, it is possible to establish that estradiol (E2) modulation with letrozole and GnRH-a triggering does not eliminate the risk of OHSS. Furthermore, it is advisable to postpone GnRH-a depot to minimize the risk of OHSS after the suspension of letrozole, following menstruation or at least 7–8 days after triggering. It would be desirable to identify high-risk patients, also on a genetic basis, in order to avoid delays in oncologic treatments that could strongly impact life expectancy.

Published in Frontiers in Reproductive Health

ISSN: 2673-3153 (Online)
Publisher: Frontiers Media S.A.
Country of publisher: Switzerland
LCC subjects: Science: Biology (General): Reproduction; Medicine: Medicine (General)
Website: https://www.frontiersin.org/journals/reproductive-health#

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