title: Regression of Adenomyosis on Magnetic Resonance Imaging after a Course of Hormonal Suppression in Adolescents: A Case Series.
abstract: OBJECTIVE
  To demonstrate that adenomyosis is a rare cause of dysmenorrhea or chronic pelvic pain (CPP) in the adolescent population that can be identified with magnetic resonance imaging (MRI) and to report resolution of adenomyosis by MRI after a course of hormonal suppression in 4 adolescents.
  
  
  METHODS
  Retrospective case series of 4 adolescents with adenomyosis on pelvic MRI at Texas Children's Hospital.
  
  
  METHODS
  Continuous oral contraceptive (COC) therapy or leuprolide acetate.
  
  
  METHODS
  Lesions on pelvic MRI after treatment.
  
  
  METHODS
  We reviewed medical records of 4 adolescents with CPP and adenomyosis on T2-weighted pelvic MRI. All patients had initial diagnostic pelvic MRI and then definitive hormonal intervention. Repeat imaging was obtained after a symptom-free interval.
  
  
  RESULTS
  Patient ages ranged from 12 to 16 years. One patient had resolution of symptoms with COC therapy. MRI performed 3 years later showed no adenomyosis. Three patients failed COC therapy. All were symptomatically improved after therapy with a gonadotropin-releasing hormone agonist. Follow-up MRI performed at intervals between 6 months and 3 years showed resolution of adenomyosis.
  
  
  CONCLUSIONS
  MRI can raise suspicion for the diagnosis of adenomyosis in adolescents with refractory CPP. Subsequent MRI can show regression of lesions after symptom resolution with hormonal therapy.
authors.affiliation: Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas. Electronic address: roshi.mansouri@gmail.com.
authors.forename: Roshanak
authors.initials: R
authors.lastname: Mansouri
authors.affiliation: Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Xiomara M
authors.initials: XM
authors.lastname: Santos
authors.affiliation: Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bercaw-Pratt
authors.affiliation: Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Dietrich
mesh_terms: D062788:Adenomyosis / Q000188:drug therapy* / Q000503:physiopathology; D000293:Adolescent; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002648:Child; D059350:Chronic Pain / Q000188:drug therapy / Q000209:etiology; D003276:Contraceptives, Oral / Q000627:therapeutic use*; D004412:Dysmenorrhea / Q000209:etiology; D004715:Endometriosis / Q000175:diagnosis; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D017699:Pelvic Pain / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D013781:Texas; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D003276:Contraceptives, Oral; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide
keywords: Adenomyosis; Adolescent; Chronic pelvic pain; Dysmenorrhea; Pelvic MRI