Knochenhauer Hope, Mohebbi Lili, Knochenhauer Eric
Northwell, New Hyde Park, New York.
Department of Obstetrics and Gynecology, Staten Island University Hospital, Staten Island, New York.
F S Rep. 2025 Jan 24;6(1):90-94. doi: 10.1016/j.xfre.2025.01.014. eCollection 2025 Mar.
To describe conservative management for accessory and cavitated uterine mass (ACUM) with norethindrone acetate. The patient gave signed written, informed consent authorizing publication.
We present a case report of a patient with ACUM who desired delay in surgical management.
The patient initially presented as a 16-year-old. She reported menses starting at the age of 11 years with increasing chronic pain and severe dysmenorrhea over the past 5 years. She was started on norethindrone acetate (5 mg orally once a day). Her periods were completely suppressed on this initial dose, and her pain resolved. After 4 years of conservative management, the patient requested definitive surgical management at the age of 20 years.
Abdominal surgery was performed 4 years after initial diagnosis after delay with norethindrone acetate.
Pathology from the procedure confirmed the diagnosis of ACUM.
On the basis of this case report, for patients with severe pain and dysmenorrhea secondary to ACUM, norethindrone acetate suppression may be a viable option. Because the patient was asymptomatic with norethindrone acetate (5 mg orally once a day), there was no need to titrate the dose higher. However, if patients continue to have pain with the starting regimen, it is reasonable to titrate the dose up to the maximum dose of norethindrone acetate (15 mg orally once daily). Although the intention for this patient was to delay surgery, for patients who are poor surgical candidates or do not desire surgical management, norethindrone acetate may be a viable, long-term option.
描述用醋酸炔诺酮对附件性及空化性子宫肿物（ACUM）进行保守治疗的情况。患者签署了书面知情同意书，授权发表此病例。
我们报告一例希望延迟手术治疗的ACUM患者的病例。
该患者初诊时16岁。她自述11岁初潮，在过去5年中慢性疼痛和严重痛经逐渐加重。开始给予醋酸炔诺酮（每日口服5毫克）治疗。最初剂量即可完全抑制其月经，疼痛也得以缓解。经过4年的保守治疗，患者在20岁时要求进行确定性手术治疗。
在最初诊断后延迟4年，用醋酸炔诺酮治疗后进行腹部手术。
手术病理证实为ACUM。
基于本病例报告，对于因ACUM导致严重疼痛和痛经的患者，醋酸炔诺酮抑制治疗可能是一种可行的选择。由于该患者服用醋酸炔诺酮（每日口服5毫克）时无症状，无需增加剂量。然而，如果患者在起始治疗方案下仍有疼痛，将剂量滴定至醋酸炔诺酮最大剂量（每日口服15毫克）是合理的。虽然该患者的目的是延迟手术，但对于手术风险高或不希望接受手术治疗的患者，醋酸炔诺酮可能是一种可行的长期选择。
