Journal of pediatric and adolescent gynecology最新文献

{"title":"13. Adolescent Levonorgestrel Intrauterine Device Experience and Satisfaction","authors":"Shannon Howard ,&nbsp;Ryan Bradley ,&nbsp;Eduardo Lara-Torre","doi":"10.1016/j.jpag.2025.01.046","DOIUrl":"10.1016/j.jpag.2025.01.046","url":null,"abstract":"<div><h3>Background</h3><div>In adolescents, the first line contraception method recommended by the American College of Obstetricians &amp; Gynecologists (ACOG) is long-acting reversible contraception (LARC) such as an IUD, yet they are rarely utilized. In numerous studies providers have reported hesitation due to patient's lack of parity and age. This study aimed to explore the experience and satisfaction of adolescents with levonorgestrel IUDs, as well as compare between the available brands (Skyla, Kyleena, and Mirena).</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed to attain patients meeting inclusion criteria (females 10-21 with IUD insertion between 2011-2021). Patients were emailed a survey obtaining age at insertion, IUD brand, reason for IUD insertion, side effects, device continuation, rate of satisfaction (1-10), et cetera. Results were used to determine satisfaction rates, overall and specific, and if satisfaction varied between IUD brands/types. Descriptive statistical analysis was performed.</div></div><div><h3>Results</h3><div>A total of 102 individuals were surveyed. Overall satisfaction was not statistically different (p = 0.2004) between levonorgestrel IUDs, with individuals overall satisfied with their IUD experience. In this study there was a statistically significant difference in the proportion of individuals experiencing significant post-insertion pain among the three IUD brands (p = 0.0282). Kyleena has the highest percentage of individuals experiencing significant post-insertion pain (65.12%), followed by Skyla (62.50%) and Mirena (54.17%).</div></div><div><h3>Conclusions</h3><div>LARCs are the first-line recommendation for contraception in adolescents. Adolescents who have levonorgestrel IUDs placed have an overall positive experience and are satisfied with their decision. There is no significant difference in satisfaction between levonorgestrel IUDs.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 235"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519729","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":"30. Effect Of Ovarian Tissue Cryopreservation On Oncologic/Autoimmune Therapeutic Timeline","authors":"Elodia Caballero,&nbsp;Megan McCracken,&nbsp;Stephanie Cizek","doi":"10.1016/j.jpag.2025.01.063","DOIUrl":"10.1016/j.jpag.2025.01.063","url":null,"abstract":"<div><h3>Background</h3><div>Fertility preservation is an integral part of comprehensive cancer care for young patients as well as other medical conditions requiring gonadotoxic treatment. As of 2019, the American Society for Reproductive Medicine considers ovarian tissue cryopreservation (OTC), the only fertility preservation option for prepubertal patients with ovaries, no longer experimental and a standard fertility preservation option. Despite these recommendations, services remain underutilized. Qualitative studies examining clinician and patient perceived barriers have cited fertility care as a secondary concern with potential impacts on delaying urgent treatment. OTC can be performed quickly, often within 5-7 days of referral, involving laparoscopic unilateral oophorectomy, which has been shown to be safe and effective in prepubertal youth. Our study aims to assess if performing OTC results in any delay in a patient's oncologic or autoimmune therapy start time.</div></div><div><h3>Methods</h3><div>A retrospective chart review of 58 patients who had undergone OTC due to anticipated gonadotoxic therapy from 1999 - 2024 in a single university hospital setting treating a primarily insured population. Treatment lag time, calculated from date of expected start date to actual start date was measured along with sociodemographic variables such as ethnicity and age at the time of OTC as well as clinical diagnosis.</div></div><div><h3>Results</h3><div>Out 58 patients who had undergone OTC, 57 patients had records available to review. 1 patient was excluded as she had no gonadotoxic treatment, yielding 56 patient records for review. The majority of the patients identified as non-Latine white at 51.7% (29/56). Mean age at the time of OTC was 21 years old, ranging from 5 months to 45 years. Mean treatment lag time was 0 days, where 98.2% (55/56) of patients had no treatment delay. The 1 patient who did have a delay, upon further chart evaluation revealed that her delay in care was due to methemaglobinemia, unrelated to her OTC.</div></div><div><h3>Conclusions</h3><div>In our study population, undergoing OTC did not delay initiation oncologic or autoimmune therapy. OTC can be performed quickly via unilateral oophorectomy in patients with planned gonadotoxic therapy and is crucial to preserve future fertility for the possibility of genetic parenthood.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 244"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519870","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":"9. Hemostatic efficacy of norethindrone acetate versus IV conjugated estrogen for adolescents presenting to the emergency room with heavy menstrual bleeding","authors":"Maeve McNamara ,&nbsp;Julia Shuford ,&nbsp;Anna Schwartz ,&nbsp;Morgan Buchanan ,&nbsp;Robert Sidonio ,&nbsp;Nancy Sokkary ,&nbsp;Megan Brown","doi":"10.1016/j.jpag.2025.01.021","DOIUrl":"10.1016/j.jpag.2025.01.021","url":null,"abstract":"<div><h3>Background</h3><div>Heavy menstrual bleeding (HMB) is a common complaint among adolescent females, but standardized guidelines for first line treatment agents are lacking in this population. A clinical pathway was developed in 2017 utilizing intravenous (IV) conjugated estrogen for acute HMB. To reduce costs and transition to oral therapy, a 2019 pathway was adapted to use oral norethindrone acetate (NA) for most patients versus IV conjugated estrogen. This study compares hemostatic efficacy of NA versus IV conjugated estrogen among adolescents with acute HMB.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed including all emergency department (ED) encounters at a tertiary children's hospital and affiliates which utilized a clinical pathway between treatment period 1 (02/01/17- 12/31/19) and 2 (01/01/21-12/31/22; excluding 2020 due to impact of COVID-19 pandemic). Demographics, laboratory tests, and treatment outcomes were collected. Hemostatic efficacy was defined as follows: length of stay (LOS), red blood cell (RBC) transfusion, tranexamic acid (TXA) utilization and menstrual suppression at 90 and 180 days. Per protocol, TXA was added if HMB persisted after 24 hours of a primary agent. T tests and chi squared statistics compared continuous and categorical variables, respectively. Multivariate logistic regression models predicted adjusted odds ratios of outcome variables (NA vs. IV conjugated estrogen), controlling for hemoglobin and treatment period.</div></div><div><h3>Results</h3><div>Between 2017-2022, 787 adolescents presented to the ED for HMB. Over half (n=402, 58.2%) were admitted and had BMI measurements, of which 126 (31.3%) received NA as primary therapy and 208 (51.7%) received IV conjugated estrogen. Receiving NA alone was associated with shorter LOS (p&lt; 0.001), fewer RBC transfusions (p=0.005) and lower TXA utilization (p=0.009) relative to receiving IV conjugated estrogen. In multivariate logistic regression, when controlling for hemoglobin and treatment period, receiving NA alone was associated with lower odds of RBC transfusion (AOR: 0.391, 95% CI: 0.182-0.838, p=0.016) and TXA utilization (AOR: 0.268, 95% CI: 0.105-0.682; p=0.006) relative to IV conjugated estrogen. We observed no significant differences in adjusted odds of LOS &gt;36 hours, or menstrual suppression at 90- and 180-day follow-up visits by hemostatic agent.</div></div><div><h3>Conclusions</h3><div>Among adolescents with acute HMB, receiving NA was associated with reduced odds of RBC transfusion and TXA utilization relative to receiving IV conjugated estrogen. NA may offer a more cost-effective option with comparable efficacy for acute HMB in adolescents.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 224-225"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520008","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":"22. Clinical and Biochemical Characteristics of Adolescent Females in the United States at Time of PCOS Diagnosis: Results from the CALICO multi-center database","authors":"Lauryn Roth ,&nbsp;Grayson Carey ,&nbsp;Laura Torchen ,&nbsp;Tim Vigers ,&nbsp;Janet Snell-Bergeon ,&nbsp;Jacqueline Reyes Diaz ,&nbsp;Anshu Gupta ,&nbsp;Manmohan Kamboj ,&nbsp;Melanie Cree ,&nbsp;CALICO Consortium","doi":"10.1016/j.jpag.2025.01.055","DOIUrl":"10.1016/j.jpag.2025.01.055","url":null,"abstract":"<div><h3>Background</h3><div>Adolescents with polycystic ovary syndrome (PCOS) are a heterogeneous population with variable phenotypes. We describe the clinical and biochemical characteristics of a regionally and racially diverse cohort of adolescents, at the time of PCOS diagnosis, in the United States.</div></div><div><h3>Methods</h3><div>These data derive from the retrospective Clinical Adolescent Polycystic Ovary (CALICO) Database, including data from 15 U.S. sites of adolescents diagnosed with PCOS per 2023 international guidelines. Data from the initial PCOS diagnostic encounter were included. Sample size differs with each variable due to documentation and clinical practice differences across sites. To harmonize differences in hormonal assays, these variables are reported as the percentage of the upper limit of normal (%ULN) for each assay. Data were divided by overweight/obesity status (BMI &gt;85%ile). Continuous variables were compared using linear model ANOVA or t-tests and categorical variables were compared using Pearson's Chi-squared test.</div></div><div><h3>Results</h3><div>This cohort includes 839 youth from across the U.S. (34.1% from the Southeast, 25.7% from the Midwest, 21% from the West, 16.2% from the Northeast, and 3% from the Southwest) who were of diverse race/ethnicity (65.5% Caucasian, 20.4% Black, 34.5% Hispanic). The median age of menarche was 11.5 years (IQR, 11, 12.5) and median age of PCOS diagnosis was 15.3 years (IQR, 14.2, 16.4). Menstrual patterns included primary amenorrhea in 9.3%, &lt; 21 days between periods in 5.0%, and &gt;45 days between periods in 85.6% of individuals. Hirsutism severity was documented in 48.7% of encounters with 34.4% reporting no hirsutism and 8.3% reporting severe hirsutism. Facial acne severity was documented in 65.4% of encounters with 26.2% reporting mild acne and 6.6% reporting severe acne. Biochemical markers including free and total testosterone, DHEA-S, FSH and LH were assessed in &gt;60% of encounters at time of diagnosis. When stratified by overweight/obese status, those with overweight/obesity had significantly higher free testosterone but lower SHBG, androstenedione and LH. There were no significant differences by weight status in total testosterone, DHEA-S, FSH or AMH (Table 1).</div></div><div><h3>Conclusions</h3><div>In this study, we characterize the presentation of adolescents at time of PCOS diagnosis in the U.S. with data collected from a geographically, ethnically and racially diverse cohort of individuals. Weight status significantly impacted the levels of some biochemical markers used in the diagnostic evaluation of PCOS.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 240-241"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519936","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":"7. A Unique Presentation of Primary Amenorrhea: Bilateral Ovarian Hyperthecosis in an Adolescent with Bardet-Biedl Syndrome","authors":"Blaire Scott ,&nbsp;Ritu Shah ,&nbsp;Minu George ,&nbsp;Lisa Moon","doi":"10.1016/j.jpag.2025.01.040","DOIUrl":"10.1016/j.jpag.2025.01.040","url":null,"abstract":"<div><h3>Background</h3><div>Ovarian hyperthecosis (OH) is a cause of hyperandrogenism (HA) primarily occurring in postmenopausal women; extensive literature review shows no cases of OH occurring in a premenarchal patient. Bardet-Biedel Syndrome (BBS) is a genetic disorder associated with a constellation of symptoms including obesity and metabolic disorders; there has been one other documented case of BBS associated with OH occurring in a 40-year-old. We present a case of OH causing primary amenorrhea and virilization in a teen with BBS.</div></div><div><h3>Case</h3><div>IRB exempt status was confirmed through our IRB process. A 15-year-old female with history of BBS presented with primary amenorrhea and HA. Exam notable for Tanner stage IV breast development, clitoromegaly, moderate acne, and hirsutism. Laboratory workup notable for significantly elevated total testosterone (TT) of 394, confirmed on repeat. No identifiable source of exogenous testosterone. Imaging studies with normal post-pubertal uterus; negative for ovarian or adrenal masses. Congenital adrenal hyperplasia and genetic testing were normal. Negative progestin challenge. Gonadal vein sampling performed, with right ovarian vein TT 4780 and all other sites TT 500-600, raising suspicion for unilateral OH. Due to medical co-morbidities, most medication options were contraindicated. Patient underwent laparoscopic right oophorectomy; OH confirmed on pathology. Following oophorectomy, TT levels initially dropped but then rose again and remained persistently elevated over 1 year. After extensive counseling and shared decision-making with the patient and family, decision was made to proceed with left oophorectomy, and pathology confirmed OH of the left ovary. IUD was placed during surgery for endometrial protection; she was started on estradiol patches for hormone replacement. FT and TT down trended to normal levels, and hirsutism and acne improved; she also reported significant improvement in her mood. Monitoring of TT levels is ongoing.</div></div><div><h3>Comments</h3><div>Identifying the etiology for HA in young patients can be difficult; PCOS is often used as a catch-all diagnosis, especially in the setting of obesity and other metabolic disorders. Our case highlights a rare cause of HA, which easily could have been mistaken for severe PCOS; in addition, treatment was particularly difficult given her co-morbidities which precluded most medication management options. We hope this case can offer an example of extended work up of HA, especially when lab values and clinical manifestations do not align, as well as one management option in a medically complex patient when standard guidelines cannot be followed.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 232-233"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519931","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":"23. Combined glue embolization and surgical excision for management of pediatric and adolescent patients assigned female at birth with genitourinary and perineal vascular anomalies","authors":"Zara Khan ,&nbsp;Anna Ujvary ,&nbsp;Maya Younoszai ,&nbsp;Giri Shivaram ,&nbsp;Katherine Debiec","doi":"10.1016/j.jpag.2025.01.056","DOIUrl":"10.1016/j.jpag.2025.01.056","url":null,"abstract":"<div><h3>Background</h3><div>Vascular anomalies (VA) encompass a broad range of tumors and malformations of the capillaries, arteries, veins or lymphatics. Often diagnosed in birth to childhood, VA affect around 5% of children, of whom an estimated 2-2.6% have genitourinary and perineal (GUP) involvement, which may contribute to pain, debility, and aesthetic concerns. A recent innovation in surgical management for VA is n-BCA glue embolization followed by surgical excision. This study reviews the technical success and clinical outcomes of this combined surgical approach for management of GUP-VA.</div></div><div><h3>Case</h3><div>For this IRB-approved retrospective chart review, patients assigned female at birth with GUP-VA who underwent glue embolization and surgical excision were identified from a large database of patients with VA who presented for care to a tertiary-care children's hospital from 1998-2024. Demographics, operative procedure and complications, and prior and subsequent treatment history were reviewed. Five female patients with GUP-VA underwent glue embolization and excision (mean age 13 years, range 3-22) between 2014-2023. Four patients presented with congenital vulvar arteriovenous or venous malformations, while one patient developed a perineal body venous malformation secondary to saddle injury. Indications for treatment included swelling (100%), pain (40%) and bleeding (20%). Two patients had undergone prior therapies, including sclerotherapy (n=1) and prior surgical excision with eventual symptom recurrence (n=1). Embolization was performed with 1:3 or 1:4 n-BCA glue in ethiodized oil. Mean lesion size was 2.9 × 2.1 × 1.4 cm. Three patients underwent excision immediately post-embolization, while two patients underwent excision the following day. The procedure was technically successful in 100% of patients: symptomatic improvement was achieved in all patients, and none experienced VA recurrence. There was one instance of nontarget glue thromboembolism to a segmental pulmonary artery; suction thrombectomy removed the majority of the glue thrombus without any change in patient's oxygenation status and no large filling defects on pulmonary arteriography. Excision procedures were uncomplicated; mean and median surgical blood loss volumes were 46 and 50 mL. One patient experienced wound separation and was monitored for wound healing by secondary intention. Mean and median follow-up duration were six and three months (range 1-14 months).</div></div><div><h3>Comments</h3><div>Combined glue embolization and excision is a safe and effective treatment option for pediatric and adolescent patients presenting with GUP-VA.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 241"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519937","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":"12. Needle-less Local Anesthetic Device for Subcutaneous Etonogestrel Insertion","authors":"Amitha Ganti ,&nbsp;Megan Sumida ,&nbsp;Olivia Winfrey ,&nbsp;Jennifer Dietrich","doi":"10.1016/j.jpag.2025.01.024","DOIUrl":"10.1016/j.jpag.2025.01.024","url":null,"abstract":"<div><h3>Background</h3><div>The subcutaneous etonogestrel implant is a first-line option for long-acting reversible contraceptive in adolescents but is often avoided due to fear of procedural pain. This early randomized control trial aimed to evaluate how a novel, needle-less device (J-Tip TM) for local anesthesia affected pain perception and overall patient satisfaction during implant insertion.</div></div><div><h3>Methods</h3><div>This IRB approved study recruited adolescents 13-21 years of age interested in the etonogestrel implant. Participants were randomized to receive intradermal lidocaine via the needle-less device or the traditional needle-based approach (control group). They were asked to complete a modified Amsterdam Preoperative Anxiety and Information Scale before and after the procedure and to report their pain scores via a 10-point Visual Analogue Scale throughout the procedure. Demographic and basic medical information were collected. Statistical analysis included student t-tests, correlation analysis, and effect size analysis with Cohen's d.</div></div><div><h3>Results</h3><div>Twenty-three participants were consented (11 controls and 12 interventions). Both groups had similar demographics and pre-procedure anxiety levels. Most were 16 years of age and denied having pre-existing mood disorders. Pain scores during lidocaine injection were significantly higher in the control group compared to the intervention group (mean = 5.8 ± 2.0 vs 0.8 ± 1.3, p&lt; 0.001, range = 3-9 vs 0-3, d = 2.95). Pain scores during Nexplanon insertion were significantly lower in the control group compared to the intervention group (mean= 0.8 ± 0.9 vs 4.1 ± 2.5, p &lt; 0.001, range = 0-2 vs range = 1-8, d = -1.81). In the post-procedure survey, recalled pain during insertion and overall satisfaction with the procedure among patients, parents and providers were not significantly different. Pre-procedure anxiety and expecting the procedure to be uncomfortable were positively correlated with increased stress during the procedure (r = 0.6, r=0.45) but not significantly correlated with any pain scores during the procedure.</div></div><div><h3>Conclusions</h3><div>While the new device may effectively reduce pain during administration of local anesthesia, its efficacy compared to traditional needle-based injection methods prior to implant insertion warrants further investigation. Our findings also emphasize the importance of managing patient expectations regarding comfort and pain, which may enhance overall satisfaction and reduce perceived pain and stress during the procedure. This study serves as a pilot to inform a larger randomized controlled trial aimed at improving the patient experience during etonogestrel implant insertions.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 227"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520019","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":"36. Estrogen Supplementation for Premature Ovarian Insufficiency Management in Adolescent with Mandibular Hypoplasia Deafness Progeroid Lipodystrophy Syndrome (MDPL)","authors":"Diamond Stevens ,&nbsp;Noor Zwayne","doi":"10.1016/j.jpag.2025.01.069","DOIUrl":"10.1016/j.jpag.2025.01.069","url":null,"abstract":"<div><h3>Background</h3><div>Mandibular hypoplasia deafness progeroid lipodystrophy syndrome (MDPL) is a rare autosomal dominant systemic disorder, which affects approximately 16 people worldwide. It is caused by mutations in the POLD1 gene, and is characterized by loss of subcutaneous fat, sensorineural deafness, along with metabolic abnormalities including diabetes mellitus, hypertriglyceridemia, and hepatic steatosis. Current literature has shown this condition to also be characterized by hypogonadism. Management of premature ovarian insufficiency with estrogen supplementation in patients with MDPL has yet to be studied.</div></div><div><h3>Case</h3><div>We present a 16-year-old female with MDPL. She was evaluated at 14 years old for delayed puberty. During evaluation, labs revealed elevated FSH levels, meeting criteria for premature ovarian insufficiency (POI). Patient was subsequently started on estradiol. Despite the dose of estrogen supplementation being increased over a 6-month period, there was minimal breast growth and concern for potential worsening of MDPL.</div></div><div><h3>Comments</h3><div>There have been 2 females reported with hypoplastic breast development. However, the current literature lacks thorough discussion of other aspects of puberty and secondary sexual characteristics in females with MDPL. Prior studies have only focused on the use of hormone replacement on solely males with this disorder. There has yet to be any cases that discuss estrogen supplementation in females with this disorder and potential effects. This particular case illustrates the complexity associated with estrogen supplementation in patients given the potential impact on MDPL. There is also a need for further studies on exogenous estradiol supplementation in individuals with MDPL and expectations for development of secondary sexual characteristics.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 247"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520120","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":"32. Endometrial hyperplasia in an adolescent with secondary amenorrhoea","authors":"Brooke Vandermolen ,&nbsp;Sophie Clarke ,&nbsp;Ephia Yasmin ,&nbsp;Hazel Isabella Learner","doi":"10.1016/j.jpag.2025.01.065","DOIUrl":"10.1016/j.jpag.2025.01.065","url":null,"abstract":"<div><h3>Background</h3><div>Endometrial cancer is the most common gynaecological malignancy globally. The incidence is increasing, particularly in younger women with obesity but has the potential to be missed in adolescents as the presenting features, such as abnormal menstrual bleeding, are common. This case describes an adolescent who was found to have endometrial hyperplasia and explores the risk factors and management of this condition.</div></div><div><h3>Case</h3><div>An 18-year-old female was referred to adolescent gynaecology with a 4 year history of chronic pelvic pain. A 9 month history of secondary amenorrhea with raised body mass index (BMI) (BMI 53kg/m2) was noted. Previous spinal MRI imaging showed suggestion of a thickened endometrial stripe [Fig1] so repeat pelvic imaging was arranged which reported endometrial thickening (19mm). Hysteroscopy and endometrial biopsy confirmed endometrial hyperplasia without atypia, and a Mirena Intrauterine System (IUS) was placed in the endometrial cavity. Repeat hysteroscopy and endometrial biopsy 7 months later showed resolution of endometrial hyperplasia but subsequent hysteroscopy and endometrial biopsy at 12 months again found endometrial hyperplasia without atypia. [Fig2]. At 15 months repeat hysteroscopy showed a more typical appearing cavity with thin endometrim, endometrial biopsy with only yielded a scanty sample but with no atypia reported. A repeat hysteroscopy and biopsy in another 6 months is planned and they are currently awaiting bariatric surgery.</div></div><div><h3>Comments</h3><div>This case report describes a rare case of confirmed endometrial hyperplasia without atypia in an adolescent. Given its premalignant potential, endometrial hyperplasia is an important diagnosis to consider in adolescents, particularly in those presenting with risk factors such as raised BMI. Ultrasound scan whilst not diagnostic for polycystic ovarian syndrome in adolescence still has an important role in considering differential diagnoses and for endometrial assessment. Ultrasonographic endometrial assessment enables risk-stratifying for adolescents who would benefit from endometrial biopsy to identify endometrial hyperplasia.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 245-246"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519879","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":"5. A rare case of 45X/46XY mosaic Turner syndrome in a neonate","authors":"Akanksha Garg,&nbsp;Adam Hittelman,&nbsp;Christina Lepore,&nbsp;Jasmine Gujral,&nbsp;Nada Derar,&nbsp;Alla Vash-Margita","doi":"10.1016/j.jpag.2025.01.038","DOIUrl":"10.1016/j.jpag.2025.01.038","url":null,"abstract":"<div><h3>Background</h3><div>Ambiguous genitalia in a newborn can be challenging to diagnose and manage. We present a case of a 2-month-old infant with atypical genitalia and genetic (45X/46XY) mosaicism.</div></div><div><h3>Case</h3><div>A healthy infant, delivered after an uncomplicated pregnancy at 39 weeks’ gestation was observed to have ambiguous genitalia. Prenatal cell-free DNA showed 40% risk for Turner's syndrome. A physical exam demonstrated an enlarged clitoris and fusion of the labioscrotal fold with a palpable mass in the left inguinal canal. Pelvic ultrasound showed a left inguinal testicle, no obvious ovarian tissue, and the presence of rudimentary Mullerian structures. Serum hormonal evaluation at 6 weeks of life included a testosterone of 118.3, ng/dL, inhibin B of 139 pg/ml, AMH of 32 ng/ml, and dihydrotestosterone level of 30 ng/dL suggesting testicular function . Estradiol levels were 3 pg/mL. Cytogenetics revealed 45X/46XY mosaicism with an SRY gene. Genitogram demonstrated a urogenital sinus. Concern was raised for potential dysgenetic gonads, which carry a risk for malignancy and a shared decision was made to pursue an exam under anesthesia and diagnostic laparoscopy to assess gonads and mullerian structures. Surgical findings included a short urogenital sinus and a 1 cm vaginal canal. A normal-appearing single cervix was visualized, and the left testicle was identified in the inguinal canal. A right-sided streak gonad (Figure 1A, black arrow), fallopian tube (Figure 1B, green arrow) and small right hemi-uterus (Figure 1D, Pink arrow) were visualized. A left inguinal orchiopexy, left inguinal hernia repair (Figure 1C) and right gonadectomy and salpingectomy (Figure 1) was performed. Pathology showed benign ovarian stroma, with rete-testes like structures. We describe one of the few cases of a neonatal diagnosis of Mosiac Turner's syndrome with the presence of both testicular and Mullerian tissue. The diagnostic challenge of such cases is that imaging modalities are limited, and surgical exploration is often necessary for definitive phenotype analysis. Furthermore, it is important to counsel parents on the potential outcomes and encourage shared decision-making to consider future options for the child's sex of rearing whilst reducing the risk of possible malignancies.</div></div><div><h3>Comments</h3><div>-We highlight a rare case of neonatal 45X/46XY Mosaic Turner's syndrome with surgical findings of a normal cervix, urogenital sinus, a left semi-descended testicle, right streak gonad and fallopian tube, and hemi-uterus -We highlight the role of shared decision-making when managing rare, complex presentations of mosaic Turner's, including reducing the risk of gonadoblastomas</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 232"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519929","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}