Interdisciplinary care and a focus on fertility preservation when multi-cystic ovaries cause ovarian torsion: A case of a 9-year-old girl with severe, undiagnosed hypothyroidism

Burns, Luke P.; Pennesi, Christine M.; Rosen, Monica W.; Araya, Adrian; Baruch, Adam; Arnold, Meghan A.; Quint, Elisabeth H.

Background Ovarian torsion can occur in Van Wyk Grumbach syndrome, a disorder characterized by severe primary hypothyroidism and ovarian enlargement. To date, all documented cases of torsion in this setting describe oophorectomy, which has significant hormonal and fertility implications. Case A nine-year-old pubertal female presented to the emergency room with abdominal pain. MRI demonstrated bilateral, multi-cystic ovaries. Operative laparoscopy confirmed unilateral adnexal torsion, and detorsion without oophorectomy was accomplished. Post-operative labs revealed severe primary hypothyroidism. Ovarian size reduced with hormone replacement therapy. Summary and Conclusion This case demonstrates that prompt, interdisciplinary intervention and awareness of severe hypothyroidism as a cause of ovarian torsion related to enlarged, multi-cystic ovaries, may reduce the rate of oophorectomy, allowing preservation of pediatric patients’ future fertility, and reducing morbidity post-operatively through prompt, long-term thyroid supplementation.