Maternal Virilization Developing during a Twin Pregnancy

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Abstract
Virilization developed in a 22-year-old woman during a twin gestation. Serum testosterone levels were elevated (912 to 1394 pg per milliliter), showed no response to ACTH infusion, fell 50 per cent (691 pg per milliliter) during dexamethasone suppression, and rose threefold (1618 pg per milliliter) with human chorionic gonadotrophin. Serum androstenedione levels were normal (2035 to 2466 pg per milliliter), responded minimally to ACTH stimulation and dexamethasone suppression, but rose appreciably during human chorionic gonadotrophin stimulation. Retrograde venous catheterization showed levels of testosterone and androstenedione higher in the right ovarian vein than in the vena cava. Bilateral theca lutein cysts were found at surgery. After ovarian wedge resection, the production rate and plasma concentration of testosterone decreased and remained normal during the following five months. Ovarian overstimulation with androgen production, secondary to multiple gestation, appeared to be the cause of the virilization.

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