Journal of pediatric and adolescent gynecology最新文献

{"title":"19. Birth Factors related to Endometriosis later in life in the light of Neonatal Uterine Bleeding (NUB)","authors":"Judith Dekker ,&nbsp;Dorthe Hartwell ,&nbsp;Anja Bisgaard Pinborg ,&nbsp;Cornelis Lambalk ,&nbsp;Velja Mijatovic ,&nbsp;Øjvind Lidegaard","doi":"10.1016/j.jpag.2025.01.052","DOIUrl":"10.1016/j.jpag.2025.01.052","url":null,"abstract":"<div><h3>Background</h3><div>Sampson's theory of Retrograde menstruation is regarded as an important origin of endometriosis but does not explain all cases of endometriosis. Especially, endometriosis occurring before and during puberty, referred to as early-onset endometriosis which might be explained by the phenomenon of neonatal uterine bleeding (NUB), as it is possibly the first retrograde menstrual bleeding and occurring around the 7th day postpartum. As NUB is more often seen in neonates born post term or after hypertension induced complicated pregnancies, endometriosis later in life might be correlated with gestational age and may show a higher prevalence in woman born after a hypertension-related complicated pregnancy.</div></div><div><h3>Methods</h3><div>Data were extracted from the Danish Health Register (update 2023) and the Medical Birth Register (Danish new-borns from 1977-1999). Women with and without endometriosis will be compared. Using cross-sectional and longitudinal models we compared the prevalence of the following parameters in both cases and controls: gestational age, birth weight, hypertensive disorders diagnosed in the pregnancy of the mother i.e. pregnancy induced hypertension, preeclampsia, HELLP.</div></div><div><h3>Results</h3><div>A total of 681970 daughters could be evaluated divided in two groups: no endometriosis (n=667524) and with endometriosis (n=14446). A significant negative correlation was seen for the parameter post term. Less daughters with endometriosis were born after the gestational age of 41 weeks. RR=0.93 (95% CI 0.90-0.96) and p&lt; 0.001. The prevalence of daughters with and without endometriosis, born after a pregnancy with all hypertensive disorders combined was similar. RR=1,00 (95% CI 0.92-1.08) and p NS. However, in the group with only hypertension or pre-eclampsia there was a slightly higher prevalence of daughters with endometriosis. RR=1.07 (95% CI 1.00-1.15) p=0.0495. This difference was even more clear in the group with hypertension or pre-eclampsia and born postterm showing a higher prevalence of daughters with endometriosis. RR = 1.19 (95% CI 1.02-1.39) p=0.03. These are preliminary results and a full evaluation of the groups is in progress at the moment.</div></div><div><h3>Conclusions</h3><div>Preliminary results not directly support the theory of NUB as an origin of endometriosis later in life. Hypertension and preeclampsia might have an association with endometriosis.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 238-239"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520119","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":"60. Kleinfelter Mosaicism in a Phenotypic Female: A Case Report","authors":"Bianca Batista ,&nbsp;Nichole Tyson","doi":"10.1016/j.jpag.2025.01.093","DOIUrl":"10.1016/j.jpag.2025.01.093","url":null,"abstract":"<div><h3>Background</h3><div>Kleinfelter Mosaicism is a rare phenomenon, with only about 20 cases of 47, XXY/ 46, XX mosaicism reported in the literature. Of these, only two patients were phenotypically female, lending little data to predict the risk of germ cell tumors or the status of future fertility for our phenotypically female patient. This poster aims to review the recorded cases of 47, XXY/ 46, XX mosaicism to increase awareness of this rare condition and to discuss the relationship of this condition to other differences in sexual development in order to assess the specific health risks our patient may face.</div></div><div><h3>Case</h3><div>Our patient presented as a 10 month old female who had an abnormal NIPT indicating an abnormality of the Y chromosome. A karyotype analysis at age 4 weeks revealed 47, XXY [5] / 46, XX [45] and subsequent FISH analysis for the SRY gene revealed the presence of the Y chromosome in 11.5% of nuclei. The patient had normal appearing external female genitalia on physical exam and had no other concerns with health or development. Labs at age 6 months revealed normal hormone levels and U/S identified a small uterus and a candidate for a right ovary, but did not visualize a left ovary. Parents opted for no intervention at this time and they were advised to request that her pediatrician provide biannual abdominal exams to assess for masses and to return to the Differences in Sexual Development clinic every 3-4 years for further evaluation.</div></div><div><h3>Comments</h3><div>Kleinfelter Syndrome as a whole is associated with higher rates of germ cell tumors than the general population. The other reported cases of 47, XXY / 46, XX type of Kleinfelter mosaicism share similarities with both ovotesticular DSD (OT-DSD) and complete gonadal dysgenesis (OT-DSD). Both of these conditions have different risks associated with germ cell tumors and different fertility profiles. All but two of these cases, however, developed as phenotypic males, leaving a gap in the medical community's understanding of how our patient might develop.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 257-258"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520124","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":"38. Exploring the Relationship Between Stress and Menstrual Cycle Abnormalities in Adolescent Females","authors":"Grace Sarris,&nbsp;Jessica Zhang,&nbsp;Tatiana Salloum,&nbsp;Katherine Hofmann,&nbsp;Daniela Fernandez-Bergnes,&nbsp;Edith Duncan,&nbsp;Judith Simms-Cendan","doi":"10.1016/j.jpag.2025.01.071","DOIUrl":"10.1016/j.jpag.2025.01.071","url":null,"abstract":"<div><h3>Background</h3><div>Abnormal menstrual patterns often result from dysregulation or immaturity of the hypothalamic-pituitary-ovarian (HPO) axis, a biological process influenced by stress and elevated cortisol levels. Prior work done in India demonstrated a link between elevated stress in teenagers and abnormal menses. Our study explores the relationship between psychological stress and irregular menstrual cycles in adolescent girls in the United States to establish baseline data to inform strategies for improving female teenage health.</div></div><div><h3>Methods</h3><div>The institution's IRB approved our study. We distributed an anonymous survey to new patients at our large university outpatient pediatric gynecology clinic. Eligible patients were non-pregnant, English or Spanish-speaking individuals under 21 years old, not on hormonal therapies, with no history of chemotherapy, radiation, uterine agenesis, or primary ovarian insufficiency. Consent from legal guardians and assent from participants was obtained as appropriate. Participants completed the survey, which included the Perceived Stress Scale (PSS), a questionnaire about their menstrual cycles, and basic demographic information. Data analysis included descriptive statistics. Categorical variables were analyzed using chi-square tests, with a p-value of &lt; 0.05 considered statistically significant.</div></div><div><h3>Results</h3><div>Of 100 participants, 64 met the criteria for abnormal menses, indicated by a frequency of menses more or less frequently than 1/month, a cycle lasting &gt;7 days or &lt; 4 days, or a heavy flow requiring 5+ changes of saturated sanitary pads/tampons daily. The majority (84%) of the population was Hispanic. Most participants reported moderate (62) to high (27) stress levels. Despite the high incidence of stress, it was not found to be a predictor of abnormal menses (p=0.71). Anxiety and depression were reported by 29 and 18 participants, respectively. These comorbidities were not predictive of stress either. Still, 74 participants reported experiencing mood changes either fairly or very often during their menstrual cycle.</div></div><div><h3>Conclusions</h3><div>The incidence of both irregular menses and elevated stress levels in our minority-majority population is notable. However, in this study, no statistically significant association was found between the two variables. Stress's impact on the HPO axis, and therefore menses, may not be as strong as previously thought, but the frequency of both variables indicates the need for a larger study. Our findings highlight the need for further research into adolescent stress to reduce these heightened levels in young girls and to better understand factors influencing menstrual abnormalities.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 247-248"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520843","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. 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}