Abstract
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.
Key Words
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Article info
Publication history
Published online: December 23, 2016
Footnotes
The authors indicate no conflicts of interest.
Identification
Copyright
© 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
