Hyperreactio luteinalis with both markedly elevated human chorionic gonadotropin levels and an imbalance of angiogenic factors subsequently developed severe early-onset preeclampsia.

OBJECTIVE: To report a case of hyperreactio luteinalis (HL) with elevated levels of human chorionic gonadotropin (hCG) and a severe imbalance of angiogenic factors, which developed into severe, early onset preeclampsia (PE). DESIGN: Case report. SETTING: University perinatal center. PATIENT(S): A 32-year-old primigravida woman with HL, high hCG levels, and severe imbalance of angiogenic factors who subsequently developed severe PE. INTERVENTION(S): Emergent cesarean section due to nonreassuring fetal status. MAIN OUTCOME MEASURE(S): Severe, early onset PE. RESULT(S): A case of HL was referred to our hospital for remarkably elevated hCG levels and bilaterally enlarged multicystic ovaries in the first trimester; the patient subsequently developed severe, early onset PE with a severe imbalance of angiogenic factors. Emergency cesarean section was performed, and she delivered a premature female infant weighing 1818 g at 32 week's gestational age. During her next pregnancy, the circulating levels of hCG and angiogenic factors remained normal, and she did not develop either PE or HL. CONCLUSION(S): Although HL complicated with PE is very rare, our case suggests that HL associated with both an elevated hCG level and an imbalance of angiogenic factors might be a risk/predictive factor for severe, early onset PE.

Hypoadiponectinemia and circulating angiogenic factors in overweight patients complicated with pre-eclampsia.

OBJECTIVE: Obesity is a risk factor for pre-eclampsia, and adiponectin is an important adipocyte-derived hormone that might protect the endothelium. Recent reports have underlined importance of circulating angiogenic factors for pathophysiology of pre-eclampsia. Here we examined whether adiponectin in conjunction with angiogenic factors plays some roles in the pathophysiology of pre-eclampsia. STUDY DESIGN: We measured serum concentrations of adiponectin and angiogenic factors, vascular endothelial growth factor, placental growth factor, and the soluble vascular endothelial growth factor receptors, soluble fms-like tyrosine Kinase 1 (sFlt-1) and soluble fetal liver kinase 1 (sFlk-1), in women with pre-eclampsia and healthy pregnant women. We also investigated the differences of these factors in overweight and normal-weight patients with pre-eclampsia. RESULTS: Significant correlations were found among the circulating adiponectin and angiogenic factors placental growth factor (R = 0.772, P = .0012) and sFlt-1 (R = 0.787, P = .0005); while, no correlation was found between adiponectin and sFlk-1 (R = 0.3, P = .3434) in patients with pre-eclampsia. Overweight patients with pre-eclampsia showed significantly lower adiponectin levels and a mild imbalance of circulating angiogenic factors, compared with normal-weight patients with pre-eclampsia. CONCLUSION: Overweight women with pre-eclampsia appeared to have lower levels of adiponectin and sFlt1 and higher levels of placental growth factor than women with pre-eclampsia who were of normal weight. These results suggest that hypoadiponectinemia might be involved in the pathophysiology of overweight patients with pre-eclampsia.

Circulating angiogenic factors in preeclampsia, gestational proteinuria, and preeclampsia superimposed on chronic glomerulonephritis.

OBJECTIVE: Recently, reports have indicated that the imbalance of circulating angiogenic factors is important in the onset of preeclampsia. In this study we investigated angiogenic factor levels in women with preeclampsia, preeclampsia superimposed on chronic glomerulonephritis, gestational proteinuria, and normal pregnancies. STUDY DESIGN: We measured several circulating angiogenic factors, placental growth factor, vascular endothelial growth factor, soluble fms-like tyrosine kinase-1, and soluble fetal liver kinase-1. RESULTS: Compared with women with normal pregnancies, placental growth factor concentrations were lower, and soluble fms-like tyrosine kinase 1 concentrations were higher in women with preeclampsia and gestational proteinuria; soluble fms-like tyrosine kinase 1 concentrations were also higher in women with preeclampsia superimposed on chronic glomerulonephritis. CONCLUSION: There were obvious differences in the levels of circulating angiogenic factors placental growth factor and soluble fms-like tyrosine kinase 1 among preeclampsia, gestational proteinuria, and controls. The imbalance of angiogenic factors is important in the onset of preeclampsia superimposed on chronic glomerulonephritis.