title: Hepatic Adenomas in Adolescents and Young Women with Endometriosis Treated with Norethindrone Acetate.
abstract: BACKGROUND
  Endometriosis-ectopic implantation of endometrial-like tissue-affects 10% of female adolescents and adults. First-line treatment includes progesterone only (such as norethindrone acetate [NET-A]) or combined estrogen/progestin oral contraceptive pills. Estrogen-containing contraceptives confer increased risk of hepatic adenomas, whereas the association with NET-A is very rarely reported.
  
  
  METHODS
  Three adolescents with stage I to II endometriosis managed with NET-A (up to 15 mg/d for 28-78 months) were diagnosed with hepatic adenomas at ages 17-22 years. They previously received estrogen-containing medications, which were stopped 24 months or longer before diagnosis of hepatic adenoma.
  
  
  CONCLUSIONS
  NET-A in a dose greater than 10 mg/d might be associated with increased risk for hepatic adenomas, likely due to peripheral conversion to ethinyl estradiol. Use of NET-A might not be advisable in patients with known hepatic adenomas.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: pbrady2@partners.org.
authors.forename: Paula C
authors.initials: PC
authors.lastname: Brady
authors.affiliation: Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Missmer
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Laufer
mesh_terms: D000236:Adenoma / Q000139:chemically induced / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D004715:Endometriosis / Q000188:drug therapy*; D004997:Ethinyl Estradiol / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging; D009640:Norethindrone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077563:Norethindrone Acetate; D055815:Young Adult
chemical_list: D003278:Contraceptives, Oral, Hormonal; D004997:Ethinyl Estradiol; D000077563:Norethindrone Acetate; D009640:Norethindrone
keywords: Abdominal pain; Endometriosis; Gynecology; Hepatic adenoma; Norethindrone; Progesterone