Journal of pediatric and adolescent gynecology最新文献

{"title":"58. Is Reproductive Health Knowledge Protective Against Adolescent Pregnancy?","authors":"Wendy Jackson,&nbsp;Stephanie Stockburger,&nbsp;Mary Nunn,&nbsp;Madison Tackett,&nbsp;Rachel Cooper","doi":"10.1016/j.jpag.2025.01.091","DOIUrl":"10.1016/j.jpag.2025.01.091","url":null,"abstract":"<div><h3>Background</h3><div>Though teen pregnancy rates are declining, it remains a pressing issue. Data is limited on prevention of teen pregnancy but contraception and engagement with family and community have been identified as protective. A more universal intervention may have more equitable results. This study aims to identify if knowledge of female genitourinary (GU) structures is associated with nulliparity in adolescents, assessed by identification of anatomical structures on a digital image. Nulliparous adolescents will identify more female GU structures correctly than parous adolescents.</div></div><div><h3>Methods</h3><div>Subjects were adolescents (12-21 years old) and patients of University of Kentucky's Adolescent Medicine Clinic (AMC) or Young Parent Program Clinic (YPP). Participant's received a $20 check through the mail after completing a survey on an iPad with questions about demographics, educational background, and identification of GU structures. The survey was offered in English and Spanish. This was a cross-sectional study with purposive sampling. Sample size was 103, 55 from the AMC and 48 from YPP. Fisher's exact, χ2, and Shapiro-Wilk normality tests were used to compare answers between the two groups. Statistical significance was set at p≤0.05, all tests were two-sided. Respective clinic attendance was the predictive variable. The primary outcome was the number and percent of GU structures identified correctly. University of Kentucky Institutional Review Board approved this study (#81195).</div></div><div><h3>Results</h3><div>The participants in AMC scored significantly higher than YPP participants having a higher median overall correct responses (17 vs 13). The median percent correct was 89.5% in the AMC group and 68.4% in the YPP group (Table 2). Therefore, the hypothesis was accepted as true. Grade of reproductive education differed significantly between groups. In the AMC group 41.1% reported education in grades 6-9, 39% beyond high school, and 20.5% received no education compared to 58.5%, 29% and 12% in the YPP group, respectively (Table 1).</div></div><div><h3>Conclusions</h3><div>These results suggest reproductive health knowledge may serve as a protective variable against teen pregnancy. Though a majority of nulliparous teens reported receiving education after high school or no education at all. Interestingly, students are taught reproductive anatomy, but these concepts are not revisited at later grade levels (10-12) when adolescents may be more likely to engage in sexual activity. Despite health education being implemented in schools, the delivery and delivery timing may be ineffective. These conclusions are limited by the cross-sectional design of the study but strengthened by a racially and ethnically diverse sample population.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 256"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"15. Asking About Gender Identity in Pediatric and Adolescent Gynecology Clinic: Patient, Family and Provider Perspectives (The REFLECTIVE Study).","authors":"Madeline Ross ,&nbsp;H. Sema Baghaki ,&nbsp;Hannah Suffian ,&nbsp;Lauren Roth ,&nbsp;Jeanette Higgins ,&nbsp;Tazim Dowlut-McElroy","doi":"10.1016/j.jpag.2025.01.048","DOIUrl":"10.1016/j.jpag.2025.01.048","url":null,"abstract":"<div><h3>Background</h3><div>The provision of medical and psychosocial supports requires the identification of gender diverse individuals in health care settings. However, in primary care settings, some adolescents and parents expressed that gender identity screening (GIS) was offensive and clinicians expressed that GIS negatively affected their workflow. We sought to assess the acceptability and feasibility of GIS in Pediatric and Adolescent Gynecology (PAG) clinics of a large tertiary care children's hospital in the United States (US) Midwest.</div></div><div><h3>Methods</h3><div>A GIS survey developed in the US West Coast was modified with permission. After IRB approval, the anonymous single-site cross-sectional survey was administered to patients ages 12-25 years (AYA), parents of the 12-to-17-year-olds, and healthcare providers (HCPs) in our PAG clinics from July through September 2024. Statistical analysis was performed using SPSS version 29 (IBM Corp, Armonk, NY). Categorical variables were compared using the Chi-Square test /Fishers’ exact test or the Kruskal-Wallis test as appropriate. Continuous variables were compared using the ANOVA test. Statistical significance was defined as P &lt;.05.</div></div><div><h3>Results</h3><div>Fifty-six participants completed the survey (Table1). The majority were 12-to17-year-olds (27, 48.2%) and their parents (16, 28.6%). The mean (SD) age of 12-to-17-year-olds, 18-to-25-years-olds, parents of 12-to-17-year-olds, and healthcare providers (HCPs) was 14.9 (1.6), 18.4 (.79), 46.8 (15.4), and 46.8 (15.4) years, respectively. Most AYA did not find GIS confusing, uncomfortable, or offensive (Table 2). An equal number of parents did/did not want parental permission prior to GIS screening for their children. Although more parents than HCPs preferred informing parents about the content of GIS before AYA were asked questions, the difference was not significant (10, 62.5% vs. 2, 33.3%, p=.348). Most 18-to-25-years-olds (4, 57.1%), parents of 12-to-17-year-olds (12, 75%), and HCPs (6, 100%) did not think that GIS should be performed in front of parents as compared to only 9 (33.3%) of 12-to-17-year-olds (p=.005). There was a statistically significant difference between the preferred method of GIS with 16 (80%) of 12-to-17-year-olds and 6 (100%) of HCPs preferring direct communication between patient and provider as compared to most 18-to-25-years-olds (5, 71.4%) who preferred to enter GIS on a computer or tablet (p=.008). HCPs did not think that GIS affected their workflow.</div></div><div><h3>Conclusions</h3><div>AYA have differing preferences for the method of GIS in PAG clinics which HCPs should take into consideration.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 236"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"57. Intralesional Cidofovir: A Promising Treatment for Refractory Genital Warts in Pediatric Patients","authors":"Mónica Muñoz ,&nbsp;Carolina Pastene ,&nbsp;Jorge Morales ,&nbsp;Patricio Garcia ,&nbsp;eugenio Ramirez ,&nbsp;Nicole Bruneau ,&nbsp;monserrat Balanda ,&nbsp;Paula Muñoz ,&nbsp;Magdalena Castro ,&nbsp;Patricia Romero","doi":"10.1016/j.jpag.2025.01.090","DOIUrl":"10.1016/j.jpag.2025.01.090","url":null,"abstract":"<div><h3>Background</h3><div>Human Papillomavirus (HPV) infections can lead to genital warts (GW) in pediatric patients, posing significant treatment challenges. Currently, no FDA-approved therapies for GW exist for children under 12, and conventional treatments often result in high recurrence rates. Emerging evidence suggests that intralesional Cidofovir, a broad-spectrum antiviral, may be effective for refractory GW, as demonstrated in related conditions like recurrent laryngeal papillomatosis.</div></div><div><h3>Case</h3><div>We present a case of a 2-year-and-8-month-old girl with persistent GW, unresponsive to multiple treatment regimens, including podophyllotoxin, liquid nitrogen, imiquimod, and trichloroacetic acid. After 2 years of failed therapies and a persistent HPV genotype 11 infection, she underwent surgical excision with intralesional Cidofovir instillation. Two years post-treatment, the patient remained asymptomatic, with no recurrence of vulvar lesions, and a negative HPV PCR molecular test. Ethics Approval: This case was reviewed and approved by the Ethics Committee of Hospital Dr. Luis Calvo Mackenna, in accordance with institutional guidelines.</div></div><div><h3>Comments</h3><div>This case underscores the potential of intralesional Cidofovir as a promising treatment for refractory GW in pediatric patients. Given the lack of approved therapies for children and the high recurrence rates associated with conventional treatments, Cidofovir may offer a new therapeutic option. Further studies are necessary to explore its efficacy as a first-line treatment for this vulnerable population. Financial Disclosure: The authors have no financial relationships relevant to this case to disclose.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 255-256"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"11. Knowledge and Awareness of Gender-Affirming Language Among Cisgender Adolescents and Their Guardians","authors":"Blair Lacy ,&nbsp;Jennifer Silk ,&nbsp;Christina Blanchard ,&nbsp;Janeen Arbuckle","doi":"10.1016/j.jpag.2025.01.023","DOIUrl":"10.1016/j.jpag.2025.01.023","url":null,"abstract":"<div><h3>Background</h3><div>Relative to their age-matched cisgender peers, transgender adolescents are more likely to suffer from mental health disorders and are at higher risk of self-harm and suicide. Social support, including use of gender-affirming language, from peers and family has been shown to be protective against these untoward mental health outcomes. We hypothesize that adolescents are more likely to positively relate to gender-affirming language than their guardian. We aim to assess the baseline knowledge and awareness of gender-affirming language among cisgender adolescents and their guardian and to examine the respective concordance or dissonance within the adolescent-guardian dyad.</div></div><div><h3>Methods</h3><div>Adolescents aged 14-21 seen in the Pediatric and Adolescent Gynecology clinic and their guardians were invited to participate in a voluntary survey regarding gender-affirming language. Adolescents ages 18-21 completed the survey without parental consent. No protected health information was gathered. Respondents completed the survey via a tablet with access to a RedCap-based questionnaire. Patients were asked to self-report their demographics including age, race, ethnicity, extent of education, and religion. Assuming a rate of acceptance of gender-affirming language among adolescents of 25% and 12.5% among guardians, 152 dyad respondents were needed to reach a power of 80%. Aggregate data from each generation and paired dyad data were analyzed using a Chi-square test for categorical data and student's t-test for continuous variables. Institutional IRB approval was obtained.</div></div><div><h3>Results</h3><div>Adolescent respondents were more likely to have pronouns they prefer (p&lt; 0.0001) and to recognize the importance of using a person's preferred pronouns (p=0.002) compared to adult respondents (Table 1). Adolescents were also more receptive to being asked their preferred pronouns, relative to the adult respondents (p=0.001). These questions were statistically significant when comparing adolescents to guardians in the paired dyad (Table 2). Self-reported level of education positively correlated with having preferred pronouns, being receptive to being asked their preferred pronouns, and utilizing a person's preferred pronouns (all p&lt; 0.05). Black race was also associated with having preferred pronouns (p=0.03).</div></div><div><h3>Conclusions</h3><div>Adolescents in this cohort demonstrated a greater awareness of the importance of gender-affirming language compared to adults. Limitations of this study are that it is single site and may not be representative of all patient populations. Surveys were also obtained with both adolescent and guardian present which may have influenced responses from either or both groups.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 226"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"13. Pain outcomes in adolescents with surgically confirmed endometriosis: A single-site retrospective cohort analysis","authors":"Madeline Ross ,&nbsp;Priyanka Suvarna ,&nbsp;Adam Booser ,&nbsp;Ashli Lawson","doi":"10.1016/j.jpag.2025.01.025","DOIUrl":"10.1016/j.jpag.2025.01.025","url":null,"abstract":"<div><h3>Background</h3><div>Endometriosis is a leading cause of dysmenorrhea globally, with two thirds of women reporting symptoms beginning in adolescence. Despite increased awareness of adolescent endometriosis, there is a paucity of data regarding best practice for surgical and medical management to improve pain outcomes. This study aims to analyze pain outcomes at one year post index surgery in adolescent patients with surgically diagnosed endometriosis.</div></div><div><h3>Methods</h3><div>This was a single-site, IRB-approved (STUDY2514), retrospective cohort study reviewing the care of natal females (12-22 years old) with surgically diagnosed endometriosis from 2009 to 2021. Baseline characteristics (demographics and preoperative clinical characteristics) were gathered from chart review. Surgery was classified as diagnostic laparoscopy only, versus ablation and/or excisional biopsy based on the surgeon's operative report. Subset analysis of post-op hormonal management with an intrauterine device (IUD) or leuprolide was performed. Changes in pain status (defined as resolved, improved, same, or worse) were gathered from the subjective documentation within gynecology appointment notes one year post-op. Statistical analysis was performed using independent t-tests and Chi-Squared/Fisher's Exact tests. Statistical significance was defined as p&lt; 0.05.</div></div><div><h3>Results</h3><div>53 patients were identified in this study period. Mean age at time of index surgery was 15 (SD 1.7) years old, and the majority had stage 1 endometriosis. 66% of patients reported their pain was improved one year after their index surgery. There was no significant difference in pain outcome at one year based on whether a patient had a diagnostic surgery only compared to ablation and/or excisional biopsy of endometriosis lesions (p=0.43). There was no significant difference in pain based on the type of hormonal regimen implemented after the index surgery, including those who had an IUD (p=0.76) or received a post-operative course of leuprolide (p=0.7). There was no statistically significant difference in pain outcomes regarding patient demographics, including age (p=0.34) and BMI (p=0.36). Regarding pre-operative clinical characteristics, patients who reported worse pain had seen one additional specialist prior to diagnosis (p=0.005).</div></div><div><h3>Conclusions</h3><div>Over two thirds of patients who underwent surgical management of endometriosis reported their pain had improved one year following surgery. Patients who had worsening pain, had seen more specialists prior to their index surgery. There was no difference in pain outcomes based on the type of surgical or hormonal intervention, or other baseline patient characteristics.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 227-228"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"14. Quantitative Sensory Testing in Females with Endometriosis and Chronic Pelvic Pain","authors":"Sinah Esther Kim ,&nbsp;Catherine Stamoulis ,&nbsp;Christine Sieberg ,&nbsp;Jenny Gallagher ,&nbsp;Beth Schwartz ,&nbsp;Stephen Scott ,&nbsp;Michele Hacker ,&nbsp;Amy DiVasta","doi":"10.1016/j.jpag.2025.01.027","DOIUrl":"10.1016/j.jpag.2025.01.027","url":null,"abstract":"<div><h3>Background</h3><div>Chronic pelvic/abdominal pain (CPP) due to endometriosis can be unresponsive to standard therapies due to excessive sensitivity to pain known as central sensitization. We studied whether quantitative sensory testing (QST), a psychophysical method examining how the somatosensory nervous system responds to stimuli, differed between females with endometriosis and pain-free individuals.</div></div><div><h3>Methods</h3><div>Females with laparoscopically-confirmed endometriosis and CPP despite hormonal medication use (pain ≥3/ 0-10 scale, ≥14 days/mo) were eligible, and underwent baseline QST for an IRB-approved, multi-site clinical trial. We measured pressure pain threshold (minimum pressure evoking pain) using an algometer, and wind-up temporal summation (perception of pain due to repetitive equally intense stimuli) using electronic Von Frey, in the lower abdomen and control areas (non-dominant third finger nailbed/deltoid). Age-matched data from 107 pain-free females were used as a reference sample. Unadjusted statistical comparisons were conducted using the Mann–Whitney U test. Statistical models with adjustments for age, race, and BMI were developed to examine statistical differences in pain outcomes. Data are reported as median (interquartile range).</div></div><div><h3>Results</h3><div>We enrolled n=85 females with endometriosis (age: 25.3 (13.4)y). Our pain-free cohort included n=107 females (age: 20 (30.0)y; Table 1). Females with endometriosis experienced median (IQR) 3(3) intensity pain, &gt;1 day/week, had lower median pain pressure thresholds (7.4 (8.1)) than the pain-free sample (16.0 (12.9); p&lt; 0.01 based on unadjusted comparisons), and higher median temporal summation of pain (2.0 (2.5) vs. 0.5 (1.0); p&lt; 0.01). These differences remained in adjusted analyses: lower pressure-pain thresholds (regression coefficient (β)=-0.28, 95% confidence interval (CI)= [-0.39, -0.18]) and higher temporal summation (β=1.69, 95% CI= [1.06, 2.31]). In females with endometriosis, median pressure pain threshold was lower on the abdomen compared with the finger (7.4 (8.1) vs. 17.1 (14.7), p&lt; 0.01). No site difference (abdomen vs. deltoid) in temporal summation was estimated (p=0.15).</div></div><div><h3>Conclusions</h3><div>Females with endometriosis had lower pressure-pain thresholds, indicating higher sensitivity to pain, and higher temporal summation measures, reflecting greater increase in pain perception from exposure to repetitive stimuli, compared with pain-free females. The pressure-pain threshold was lower at the lower abdomen vs. finger in those with endometriosis, but temporal summation was the same. Clinicians should consider treatments aimed at reducing central sensitization to pain in those with CPP due to endometriosis.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 228"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"53. Implementation of an Enhanced Recovery After Surgery Pathway in Adolescent Patients Undergoing Laparoscopic Evaluation of Endometriosis","authors":"Lauren Roth ,&nbsp;Madeline Ross ,&nbsp;Ashli Lawson ,&nbsp;Todd Glenski ,&nbsp;Emily Weisberg","doi":"10.1016/j.jpag.2025.01.086","DOIUrl":"10.1016/j.jpag.2025.01.086","url":null,"abstract":"<div><h3>Background</h3><div>In July 2023, a multi-disciplinary team from a tertiary children's hospital implemented an enhanced recovery after surgery (ERAS) pathway to standardize care and improve the perioperative experience for adolescents undergoing diagnostic laparoscopy for endometriosis. Pathway components include pre-operative gynecologic and anesthesia visits, intraoperative multimodal analgesia, and postoperative management (Fig 1 &amp; 2). This study aimed to (1) assess perioperative compliance to the Endometriosis ERAS pathway, and (2) evaluate patient metrics as indicators for pathway efficacy pre- and post- pathway implementation.</div></div><div><h3>Methods</h3><div>This was an IRB approved, single-site study of patients aged 12-20 undergoing laparoscopy for endometriosis. Data was collected from 6/2022-6/2023 (pre-ERAS) and 8/2023- 8/2024 (post-ERAS). To assess pathway compliance (aim 1) the rates of preoperative prescription, referral placement, day of surgery preoperative medication, preoperative carbohydrate loading, intraoperative anesthesia bundle, and postoperative prescriptions were measured. Post Anesthesia Care Unit (PACU) length of stay, discharge pain score, and patient concerns (ER visit, phone call/message, or readmissions) were interpreted as surrogate metrics for pathway efficacy (aim 2) and were analyzed pre and post intervention using independent t-tests and Chi squared/Fisher's exact tests. All data analysis was performed using SPSS.</div></div><div><h3>Results</h3><div>53 patients were included (20 pre and 33 post-ERAS). Mean age was 16.6 years (SD 1.7). Compliance was as follows: 81% preoperative prescriptions, 45% pain management referrals, 33% physical/occupational therapy, 76% day of surgery preoperative medications, 39% preoperative carbohydrate load, 87% intraoperative bundle compliance, and 61% postoperative prescriptions. PACU length of stay, discharge pain scores, and patient concerns were not significantly different pre vs post ERAS.</div></div><div><h3>Conclusions</h3><div>The Endometriosis ERAS pathway was a multidisciplinary team effort and has overall high compliance but leaves room for improvement in some facets (particularly specialty referrals and preoperative carbohydrate loading). While our data does not show improved patient metrics in the pre vs post pathway group, this is likely reflective of our efforts to emulate this pathway in the year leading up to implementation. Future directions include: analyzing a pre-ERAS group more remote from the pathway start date, revisiting the multidisciplinary team to see what barriers exist to improve compliance, and eliciting qualitative feedback from patients about their perspective.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 254-255"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"45. FOXL2-induced BPES and POI with Hyperandrogenism and Normal Estradiol: A Clinical Conundrum","authors":"Jennifer Silk,&nbsp;Katelyn Day,&nbsp;Janeen Arbuckle","doi":"10.1016/j.jpag.2025.01.078","DOIUrl":"10.1016/j.jpag.2025.01.078","url":null,"abstract":"<div><h3>Background</h3><div>Patients with FOXL2 resulting in BPES (blepharophimosis, ptosis, epicanthus inversus syndrome) are at an increased risk of premature ovarian failure (POI). Hyperandrogenism alongside normal estradiol levels in the setting of POI is not noted in the literature.</div></div><div><h3>Case</h3><div>A 15-year-old female with a known history of FOXL2 gene and BPES presented to pediatric gynecology (PAG) due to secondary amenorrhea after experiencing only one episode of menses at age 12. Thelarche occurred at age 9 and prior workup was notable for elevated free and total testosterone, DHEAS, and FSH. She had a prior normal estradiol, prolactin, karyotype, 21-hydroxylase antibodies, thyroid antibodies, and Fragile X screen. Her physical exam was remarkable for tanner 4 tuberous breast and thick course hair on the face, check, and back consistent with hirsutism. Repeat FSH remained extremely elevated and estradiol remaining within normal pubertal range. Given persistent androgen excess on labs and physical exam findings, a pelvic ultrasound and CT abdomen/pelvis was completed to rule out tumors of the adrenal glands or ovaries which were unremarkable. Because her FSH remained persistently elevated with normal estradiol, an AMH was completed and noted to be 0.1. She also completed a DEXA scan which showed normal bone mineral density. She subsequently completed a congenital adrenal hyperplasia (CAH) panel which was normal with the exception of elevated testosterone. The patient attempted a Provera challenge with no withdrawal bleed. With known genetic predisposition and two FSH levels markedly elevated, patient formally met criteria for POI. Despite extensive workup, no etiology was identified for her persistent androgen excess but given her clinical and laboratory findings, she did meet criteria for PCOS. Interestingly her estrogen level remained within normal limits despite the diagnosis of POI. She was started on oral contraceptive pills for hirsutism, hormone replacement, and contraception.</div></div><div><h3>Comments</h3><div>Given the rarity of documented associations between BPES, hyperandrogenism, and normal estradiol levels in the setting of POI, other conditions like PCOS should be considered in said patients. This case emphasizes the importance of extensive laboratory and imaging workup for unique patients as well as the value of multidisciplinary teamwork between genetics, PAG, and reproductive endocrinology. In addition, the providers recognized the importance of monitoring bone health and contraceptive needs in this unusual clinical scenario.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 250"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"25. Correlation of serum inhibin B and radiographic hemorrhagic cyst: A case for conservative management","authors":"Jennifer Silk,&nbsp;Sarah Hill,&nbsp;Laura Stafman,&nbsp;Blair Lacy","doi":"10.1016/j.jpag.2025.01.058","DOIUrl":"10.1016/j.jpag.2025.01.058","url":null,"abstract":"<div><h3>Background</h3><div>Ovarian neoplasms occur 2.6 per 100,000 in the child and adolescent population and are usually benign in nature. The incidence of pediatric ovarian malignancy is poorly understood, as it is exceedingly rare, though when present, adnexal masses are diagnosed as gynecologic malignancy 3-8% of the time. Tumors markers like inhibins can be used to differentiate between benign and malignant lesions. Inhibin B is generally thought to be elevated in granulosa cell malignancies and can be a cause of primary or secondary amenorrhea. No literature, however, has demonstrated an association with an elevation of inhibin B with benign pathologies as discussed in this case.</div></div><div><h3>Case</h3><div>A 12-year-old female presented to pediatric gynecology with a left adnexal mass incidentally noted on renal ultrasound while undergoing evaluation for pediatric hypertension. Menarche occurred at age 11 with regular monthly cycles. An abdominal ultrasound and CTAP were notable for a 5.3 × 4.9 × 4.2cm thin walled cyst in left ovary concerning for hemorrhagic cyst. Labs demonstrated normal estradiol, testosterone, aldosterone, bHCG, inhibin A, and AFP. Inhibin B was elevated to 464. Given patient age and reassuring findings on ultrasound, it was ultimately decided to trend serum inhibins, mass size with ultrasound, and consult pediatric surgery given possible gynecologic malignancy. Repeat imaging 4 weeks later showed a stable hemorrhagic cyst and down trending inhibin B at 180. At 8 weeks from onset, imaging demonstrated interval resolution hemorrhagic cyst and inhibin B at 118. Given the improvements, repeat imaging and inhibin was obtained five months later with no evidence of recurrence of hemorrhagic cyst and normalized inhibin B at 35.</div></div><div><h3>Comments</h3><div>Limited data exists regarding conservative treatment of adnexal masses that are benign in nature in the setting of elevated tumor markers in pediatric and adolescent patients. In this case, a benign appearing lesion was associated with elevations of inhibin B, which raised concern for gynecologic malignancy. In absence of high-risk ultrasonographic features or symptoms of hyperestrogenism that one would expect in juvenile granulosa cell tumor, the clinical picture was consistent with benign pathology. Thus, inhibin was trended to normal range and correlated with simultaneous resolution of the cyst. An unnecessary surgical procedure was avoided in this asymptomatic patient. Further studies need to be collected to validate the use of trending inhibin B in the setting of benign adnexal pathologies like hemorrhagic cysts.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 242"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"27. Diagnosis of Imperforate Hymen: A Case Study for Quality Improvement","authors":"Avanthi Ajjarapu,&nbsp;Jennifer Dietrich","doi":"10.1016/j.jpag.2025.01.060","DOIUrl":"10.1016/j.jpag.2025.01.060","url":null,"abstract":"<div><h3>Background</h3><div>Imperforate hymen, transverse vaginal septum, vaginal agenesis, and lower vaginal atresia are four common forms of vaginal outlet obstruction. Early differentiation between these anatomic variants is crucial to determine a correct diagnosis and ensure appropriate surgical timing to avoid unnecessary surgical revision or complication. Distinguishing between these variants relies initially on physical exam. When characteristic components are absent, it is critical to obtain imaging to distinguish between other obstructive vaginal anomalies as the presence of hematocolpos or hematometra may occur with many types of obstructive mullerian anomalies. A pelvic ultrasound may be ordered initially as it is more readily available but may not yield enough detailed information. In this circumstance, further imaging should be obtained prior to surgical intervention with Pelvic MRI; the gold standard imaging modality for reproductive tract anomalies. This case reminds the provider of the steps to take for the correct diagnosis as well as recommendations for specialist referral when the presentation is not that of a bulging membrane with blue hue at the introitus.</div></div><div><h3>Case</h3><div>A 13 yo female presented to an outside emergency room with severe, cyclic abdominopelvic pain. A pelvic ultrasound suggested hematometra. She was taken to the operating room due to pelvic exam findings concerning for no vaginal patency. A vaginal dimple was present without blue hue or bulging noted. Intraoperatively, an incision did not reveal release of menstrual contents. The surgery was aborted due to findings inconsistent with imperforate hymen. MRI Pelvis was ordered later and a diagnosis of cervicovaginal agenesis with hematometra was made. Menstrual suppression was then initiated with GnRh antagonist orally. A few years later, the patient was referred to Pediatric and Adolescent Gynecology.</div></div><div><h3>Comments</h3><div>For complex reproductive tract anomalies, pelvic MRI should be ordered following pelvic US as MRI best correlates with the type of anomaly. Avoid going to the operating room if the classic presentation of imperforate hymen is not visualized and confirmed to minimize complications. Optimize pain management to allow time to obtain adequate MRI Pelvis with contrast for optimal delineation of hymenal versus other vaginal and mullerian variants. This includes assessing distance from introitus to defect. Refer to a specialist with expertise in managing obstructive reproductive tract anomalies, when an anomaly other imperforate hymen is suspected.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 243"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}