接受醋酸炔诺酮治疗的患有子宫内膜异位症的青少年及年轻女性的肝腺瘤
Hepatic Adenomas in Adolescents and Young Women with Endometriosis Treated with Norethindrone Acetate.
作者信息
Brady Paula C, Missmer Stacey A, Laufer Marc R
机构信息
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts.
Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan.
出版信息
J Pediatr Adolesc Gynecol. 2017 Jun;30(3):422-424. doi: 10.1016/j.jpag.2016.12.002. Epub 2016 Dec 23.
BACKGROUND
Endometriosis-ectopic implantation of endometrial-like tissue-affects 10% of female adolescents and adults. First-line treatment includes progesterone only (such as norethindrone acetate [NET-A]) or combined estrogen/progestin oral contraceptive pills. Estrogen-containing contraceptives confer increased risk of hepatic adenomas, whereas the association with NET-A is very rarely reported.
CASE
Three adolescents with stage I to II endometriosis managed with NET-A (up to 15 mg/d for 28-78 months) were diagnosed with hepatic adenomas at ages 17-22 years. They previously received estrogen-containing medications, which were stopped 24 months or longer before diagnosis of hepatic adenoma.
SUMMARY AND CONCLUSION
NET-A in a dose greater than 10 mg/d might be associated with increased risk for hepatic adenomas, likely due to peripheral conversion to ethinyl estradiol. Use of NET-A might not be advisable in patients with known hepatic adenomas.
背景
子宫内膜异位症——子宫内膜样组织的异位植入——影响10%的青春期及成年女性。一线治疗包括单纯孕激素（如醋酸炔诺酮[NET-A]）或雌激素/孕激素复方口服避孕药。含雌激素的避孕药会增加肝腺瘤风险，而与NET-A的关联则鲜有报道。
病例
三名患有I至II期子宫内膜异位症且接受NET-A治疗（剂量高达15毫克/天，持续28 - 78个月）的青少年在17至22岁时被诊断出患有肝腺瘤。她们之前曾服用含雌激素药物，在肝腺瘤诊断前24个月或更长时间停药。
总结与结论
剂量大于10毫克/天的NET-A可能与肝腺瘤风险增加有关，这可能是由于其在外周转化为炔雌醇所致。对于已知患有肝腺瘤的患者，可能不宜使用NET-A。
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