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Primary adenoma of the liver with spontaneous rupture following long-term intake of gestagens. Case report

Primary adenoma of the liver with spontaneous rupture following long-term intake of gestagens. Case report

Der Internist 24(5): 286-288

A case report of a 26-year old woman on chronic hemodialysis for pyelonephritis who took 10 mg of norethisterone acetate daily for suppression of menstruation. 1 week before admission colic-like pains appeared in right upper abdominal quadrant which were relieved by spasmolytics. Laboratory parameters (except those related to renal insufficiency), physical examination, x-rays of chest, stomach and biliary tract showed no abnormalities. Sonography revealed various round space-occupying lesions in the lower liver lobe. Before further studies could be initiated and following a hemodialysis session patient died of an intrahepatic hemorrhage confirmed by ultra-sonic and CAT-scan. Autopsy showed a large hematoma with more than 700 ml coagulated blood which caused rupture of the right liver lobe. Round adenomas were found in both lobes. The relationship between oral contraceptives and primary liver adenomas in young women without previous liver disease has been reported in the literature since 1973. 200 cases were found in the literature since 1977. Although mostly estrogens are blamed for liver adenomas, in this case it was a pure progestogen preparation. In another study of women with primary liver adenomas only 1 in 100 women used a pure progestin contraceptive. A relationship between androgens or anabolic steroids has been found in a number of case reports in the literature. It can be assumed that both combination preparations with estrogen components, and pure progestin preparations play a similar role in the pathogenesis of benign liver tumors.

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Accession: 044031046

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PMID: 6347951

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