Influence of progestin-only hormonal use on hepatocellular adenomas: A retrospective cohort study.
Humans
Female
Adult
Adolescent
Young Adult
Middle Aged
Progestins
/ adverse effects
Retrospective Studies
Adenoma, Liver Cell
/ chemically induced
Carcinoma, Hepatocellular
/ chemically induced
Liver Neoplasms
/ chemically induced
Contraceptives, Oral, Hormonal
/ adverse effects
Steroids
Progesterone Congeners
Estrogens
/ adverse effects
Contraceptive agents
Estrogens
Hepatocellular adenoma
Progestins
Women's health
Journal
Contraception
ISSN: 1879-0518
Titre abrégé: Contraception
Pays: United States
ID NLM: 0234361
Informations de publication
Date de publication:
03 2023
03 2023
Historique:
received:
10
09
2022
revised:
09
11
2022
accepted:
28
11
2022
pmc-release:
01
03
2024
pubmed:
9
12
2022
medline:
22
2
2023
entrez:
8
12
2022
Statut:
ppublish
Résumé
Exogenous estrogen is associated with growth of hepatocellular adenomas (HCAs), although the influence of progestin-only agents is unknown. We therefore evaluated the association of progestin-only agents on HCA progression compared to no hormone exposure and compared to estrogen exposure in female patients. In this single-center, retrospective cohort study of reproductive-aged female patients (ages 16-45) with diagnosed HCAs between 2003 and 2021, we evaluated radiographic HCA growth during discrete periods of well-defined exogenous hormone exposures. A total of 34 patients were included. Nineteen (55.9%) had follow-up scans during periods without hormone exposure, 7 (20.6%) during estrogen exposure, and 8 (23.5%) during progestin-only exposure. Over a median follow-up of 11 months, percent change in sum of adenoma diameters from baseline to last available scan was -15.0% with progestin-only agents versus 29.4% with estrogen exposure (p = 0.04), and -7.4% with no hormonal exposure (p = 0.52 compared to progestin-only). Greater than 10% growth was observed in two individuals (25.0%) with progestin-only agent use (one patient on high-dose progestin for menorrhagia) versus five individuals (71.4%) with estrogen use (p = 0.13), and 7 (36.8%) with no exogenous hormone use (p = 0.68 vs progestin-only). During discrete periods of progestin-only use, HCA growth overall declined, similar to declining growth during periods without exogenous hormonal exposure. This differed from discrete periods of exogenous estrogen exposure, during which time HCAs demonstrated overall increased growth. Though larger studies are needed, these findings support recent guidance supporting progestin-only agents for female patients with HCAs seeking non-estrogen alternatives for contraception. In this small retrospective study, we observed overall decrease in HCA size during discrete periods of progestin-only contraception use, similar to that observed during periods without exogenous hormone exposure, supporting their use as a safe alternative to estrogen-containing contraceptives in this patient population.
Identifiants
pubmed: 36476331
pii: S0010-7824(22)00439-5
doi: 10.1016/j.contraception.2022.11.006
pmc: PMC10266542
mid: NIHMS1904964
pii:
doi:
Substances chimiques
Progestins
0
Contraceptives, Oral, Hormonal
0
Steroids
0
Progesterone Congeners
0
Estrogens
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
109915Subventions
Organisme : NIDDK NIH HHS
ID : P30 DK026743
Pays : United States
Organisme : NIDDK NIH HHS
ID : R03 DK131238
Pays : United States
Informations de copyright
Copyright © 2022 Elsevier Inc. All rights reserved.
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