Diferencia entre revisiones de «Adenomyosis»
| Línea 14: | Línea 14: | ||
===Reproductive Tract Causes=== | ===Reproductive Tract Causes=== | ||
*Atrophic endometrium | *Atrophic endometrium | ||
*Dysfunctional uterine bleeding | *[[Dysfunctional uterine bleeding]] | ||
*Endometriosis | *[[Endometriosis]] | ||
*Fibroids | *Fibroids | ||
*Foreign Body | *[[Foreign Body]] | ||
*Infection (vaginitis, PID) | *Infection ([[vaginitis]], [[PID]]) | ||
*IUD | *IUD | ||
*Neoplasia | *Neoplasia | ||
*Uterine polyp | *Uterine polyp | ||
*Vaginal Trauma | *[[Vaginal Trauma]] | ||
===Systemic Causes=== | ===Systemic Causes=== | ||
Revisión del 23:05 14 dic 2020
Background
- Uterine disorder characterized by endometrial glands and stroma being present within the myometrium resulting in hypertrophy of the surrounding myometrium
- Two histopathological forms:
- Diffuse – results in the uterus being uniformly enlarged and boggy
- Focal (also known as an adenomyoma) – can appear similar to a fibroid but does not have a pseudocapsule
- Pathogenesis is not well understood
Clinical Features
- Heavy menstrual bleeding
- Dysmenorrhea
- Chronic pelvic pain
Differential Diagnosis
Reproductive Tract Causes
- Atrophic endometrium
- Dysfunctional uterine bleeding
- Endometriosis
- Fibroids
- Foreign Body
- Infection (vaginitis, PID)
- IUD
- Neoplasia
- Uterine polyp
- Vaginal Trauma
Systemic Causes
- Cirrhosis
- Coagulopathy (Von Willebrand disease, ITP)
- Group A strep vaginitis (prepubertal girls)
- Hormone replacement therapy
- Hypothyroidism
- Secondary anovulation
Evaluation
- Pelvic exam – bimanual usually reveals a mobile, enlarged, and soft or boggy uterus
- Transvaginal US
- MRI usually reserved in cases when providers are seeking to distinguish between adenomysosis and leiomyomas [1]
- Definitive diagnosis relies on histology, and so it is usually made during pathology examination of the uterus after a hysterectomy
Management
- Hysterectomy is the definitive treatment
- Alternative options include
- Uterine artery embolization
- Uterus sparing resection
Disposition
- Final disposition should be made based on hemodynamic stability of the patient
- If hemodynamically stable without clinically significant bleeding, patient can be discharged with gynecology referral
References
- ↑ Byun JY, Kim SE, Choi BG, Ko GY, Jung SE, Choi KH. Diffuse and focal adenomyosis: MR imaging findings. Radiographics. 1999;19 Spec No:S161-S170. doi:10.1148/radiographics.19.suppl_1.g99oc03s161
- ↑ Fong YF, Singh K. Medical treatment of a grossly enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system. Contraception. 1999;60(3):173-175. doi:10.1016/s0010-7824(99)00075-x
- ↑ Fedele L, Bianchi S, Raffaelli R, Portuese A, Dorta M. Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril. 1997;68(3):426-429. doi:10.1016/s0015-0282(97)00245-8
- ↑ Sheng J, Zhang WY, Zhang JP, Lu D. The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis. Contraception. 2009;79(3):189-193. doi:10.1016/j.contraception.2008.11.004