Current Approaches to Optimizing the Treatment of Endometriosis in Adolescents
Current Approaches to Optimizing the Treatment of Endometriosis in Adolescents
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DOI：
10.1159/000148027
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发表时间：
2008-01-01
影响因子：
2.1
通讯作者：
Laufer, Marc R.
中科院分区：
文献类型：
--
作者：
Laufer, Marc R.
子宫内膜异位症可发生在青少年，这一患者组在鉴别诊断、不同的表现和症状以及治疗选择方面提出了特别的挑战。早期诊断对于减轻疼痛、希望防止疾病进展和保护未来的生育能力至关重要。子宫内膜异位症的手术通常是细胞减少性的，而不是根治性的，无论疾病的分期如何，术后都应该开始药物治疗。雌激素/孕激素持续联合应用的月经抑制疗法是大多数青少年子宫内膜异位症的主要治疗方法。对于那些持续使用这种疗法的疼痛患者，促性腺激素释放激素(GnRH)激动剂(配合加回疗法)可以有效地缓解症状。促性腺激素释放激素激动剂治疗需要在青少年中特别考虑，因为可能会对骨矿化产生不利影响--对于处于骨密度(BMD)增加关键年龄的青少年来说，这是一个重要的考虑因素。然而，潜在的骨丢失问题可以通过使用“增加背部”疗法来避免。最近的一项临床研究发现，大多数接受促性腺激素释放激素激动剂加醋酸去甲肾上腺素(NA)或雌激素加去甲肾上腺素治疗的子宫内膜异位症青少年髋部骨密度正常。加回疗法似乎是GnRH激动剂治疗预防骨丢失的一种有前景的辅助疗法，并且可能比单独使用GnRH激动剂的治疗持续时间更长。在最初的6-8个月治疗后，应该继续仔细监测BMD，然后大约每两年监测接受长期GnRH激动剂加回治疗的青少年患者(16岁以上)的骨密度。版权所有(C)2008 S.Karger AG，巴塞尔
Endometriosis can occur in adolescents and this patient group presents particular challenges in terms of differential diagnosis, variable presentation and symptoms, and choice of treatment. Early diagnosis is essential in order to decrease pain and hopefully prevent disease progression and preserve future fertility. Endometriosis surgery is generally cytoreductive rather than curative, and postoperative medical therapy should be initiated regardless of disease stage. Menstrual suppressive therapy with the use of continuous combination estrogen/progestin is the main treatment for most adolescents with endometriosis. For those with a persistence of pain on this therapy Gonadotropin-releasing hormone (GnRH) agonists (with add-back therapy) can be effective in relieving symptoms. GnRH agonist therapy requires special consideration in adolescents due to possible adverse effects on bone mineralization - an important consideration in adolescents who are at a critical age for accrual of bone mineral density (BMD). However, potential problems of bone loss may be avoided with the use of 'add back' therapy. A recent clinical study found that most adolescents with endometriosis receiving a GnRH agonist plus add-back therapy with norethindrone acetate (NA) or estrogen plus NA had normal BMD at the hip. Add-back therapy appears to be a promising adjunct to GnRH agonist therapy for the prevention of bone loss and may allow a longer duration of therapy than with a GnRH agonist alone. BMD should continue to be carefully monitored after the initial 6-8 month period of therapy and then approximately every two years in adolescent patients (over age 16) receiving long-term GnRH agonist with add-back therapy. Copyright (C) 2008 S. Karger AG, Basel