Norethisterone-induced hepatic adenomas can cause life-threatening bleeding in girls with inherited platelet disorders

Crosnier, H.; Thibaud, E; Duflos, C.; Polak, Michel

doi:10.1016/j.fertnstert.2010.03.045

Cited by 8 publications

(4 citation statements)

References 30 publications

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“…12 Another article described 4 cases of hepatic adenomas in patients with inherited platelet disorders. 13 In all these cases, lifethreatening hemorrhage can occur from the adenomas due to the coagulopathy, so progestin only pills must be prescribed with caution in such patients.…”

Section: Discussionmentioning

confidence: 99%

Norethisterone–induced cholestasis: the hidden alarm

Dauleh¹

2019

IPCB

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Combined oral contraceptives have a well-known side effect of causing a reaction similar to intrahepatic cholestasis of pregnancy. This has been thought to be largely due to the estrogen component of contraceptives. However, in this case report, we delineated the case of cholestasis in a middle-aged woman who has been receiving norethisterone, a progestogen only pill, for symptomatic fibroids. Within 2 months of starting norethisterone, this patient developed hepatomegaly and jaundice. Her labs showed abnormalities of liver function indicative of a cholestatic picture. Upon discontinuation of norethisterone and starting ursodeoxycholic acid, her liver functions began to trend down and returned to normal within a month. There have been similar case reports; however, the data is lacking with regards to establishing a correlation. Awareness of unanticipated side effects of a drug such as norethisterone is crucial in the prompt recognition and treatment of cholestasis should it arise. Moreover, knowledge is lacking with regards to the effect of progesterone on the liver in general and on developing cholestasis in particular.

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Section: Discussionmentioning

confidence: 99%

Norethisterone–induced cholestasis: the hidden alarm

Dauleh¹

2019

IPCB

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“…The AFP levels are usually normal and a rise in AFP indicates malignant transformation [118]. An association of HCA has been reported with excessive estrogen exposure, norethindrone and norethisterone (synthetic progesterone) administration, and excess androgen exposure, and the tumor regresses after the factors causing excessive hormone exposure are alleviated [119][120][121][122][123][124]. HCA has an incidence range of 75-80% in patients with glycogen storage disease (GSD) and it develops during the second and third decades of life.…”

Section: Clinical Presentationmentioning

confidence: 99%

Update on the Pathology of Pediatric Liver Tumors: A Pictorial Review

Bhagat,

Vij,

Raju

et al. 2023

Diagnostics

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Liver tumors in children are uncommon and show remarkable morphologic heterogeneity. Pediatric tumors may arise from either the epithelial or mesenchymal component of the liver and rarely may also show both lines of differentiation. Both benign and malignant liver tumors have been reported in children. The most common pediatric liver tumors by age are benign hepatic infantile hemangiomas in neonates and infants, malignant hepatoblastoma in infants and toddlers, and malignant hepatocellular carcinoma in teenagers. Here, we provide an up-to-date review of pediatric liver tumors. We discuss the clinical presentation, imaging findings, pathology, and relevant molecular features that can help in the correct identification of these tumors, which is important in managing these children.

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“…HCA are more common in women and obese men, secondary to peripheral production of estrogen from adipose tissue, and are associated with high potency combined estrogen/progestin oral contraceptives [ 99 , 100 ]. Norethindrone and noresthisterone, both synthetic progesterones, have also recently been implicated in HCA development, likely secondary to peripheral conversion to ethinyl estradiol [ 99 , 101 ]. Crosnier et al reported a case series of four young women (aged 14–24) with recessive inherited platelet disorders who were receiving continuous noresthisterone treatment to induce amenorrhea.…”

Section: Benign Tumors In School-aged Children and Adolescentsmentioning

confidence: 99%

“…All four of these patients developed HCA, two of whom presented with life-threatening hemorrhage secondary to ruptured HCA. All patients had spontaneous regression of HCA after cessation of noresthisterone [ 101 ]. Androgens have also been associated with HCA and are commonly used in the treatment of patients with endocrine abnormalities, aplastic anemias, hereditary angioedema, muscle mass development, and in transgender individuals [ 102 ].…”

Section: Benign Tumors In School-aged Children and Adolescentsmentioning

confidence: 99%

Pediatric Primary Hepatic Tumors: Diagnostic Considerations

2021

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The liver is the third most common site of abdominal tumors in children. This review article aims to summarize current evidence surrounding identification and diagnosis of primary hepatic tumors in the pediatric population based upon clinical presentation, epidemiology, and risk factors as well as classical imaging, histopathological, and molecular diagnostic findings. Readers will be able to recognize the features and distinguish between benign and malignant hepatic tumors within different age groups.

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Norethisterone-induced hepatic adenomas can cause life-threatening bleeding in girls with inherited platelet disorders

Cited by 8 publications

References 30 publications

Norethisterone–induced cholestasis: the hidden alarm

Norethisterone–induced cholestasis: the hidden alarm

Update on the Pathology of Pediatric Liver Tumors: A Pictorial Review

Pediatric Primary Hepatic Tumors: Diagnostic Considerations

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