Abstract
Objectives
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.
Study design
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.
Results
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).
Conclusions
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.
Implications
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.
Keywords
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Article info
Publication history
Published online: December 03, 2022
Accepted:
November 28,
2022
Received in revised form:
November 9,
2022
Received:
September 10,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
