Postoperative hormonal modulation in a patient with granulosa cell tumor and myasthenia gravis: a gyneco-oncologic perspective.

INTRODUCTION AND

IMPORTANCE

Perioperative management of granulosa cell tumors (GCTs) becomes significantly more complex in patients with neuromuscular conditions such as myasthenia gravis (MG). Herein, we describe a case of surgically managed stage I GCT in a woman with MG and hypothyroidism. This case is unique because the patient developed postoperative cardiac instability attributed to abrupt estrogen withdrawal after oophorectomy, which resolved rapidly with estrogen replacement.

CASE PRESENTATION: A 38-year-old woman (gravida 0, para 0), married for 8 years, and who is a known case of MG and hypothyroidism presented to our center with a 2-week history of dull lower abdominal pain, intensifying during menstruation. The MRI raised a suspicion of malignancy after which the patient was taken for comprehensive staging surgery in which abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. On post-op day 3, she developed palpitations, chest discomfort, progressive fatigue, and drowsiness. The patient was successfully managed with oral estradiol and discharged on post-op day 9.

CLINICAL DISCUSSION: From a gynecologic oncologic perspective, comprehensive surgical staging remains the standard of care for apparent early-stage AGCT. In our case, the patient's co-morbid MG added significant complexity to the perioperative planning. The cardiac arrhythmia developed as a result of sudden withdrawal of estrogen due to oophorectomy was successfully managed with oral estradiol, and the patient was successfully discharged.

CONCLUSION

Prompt recognition of post-oophorectomy hormonal withdrawal and judicious use of estrogen therapy may be essential in mitigating postoperative complications in hormone-sensitive tumors like AGCTs.