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Influence of progestin-only hormonal use on hepatocellular adenomas: A retrospective cohort study

  • Author Footnotes
    1 Current affiliation: Department of Medicine, University of California San Diego, San Diego, 92103
    Zoya Qureshy
    Footnotes
    1 Current affiliation: Department of Medicine, University of California San Diego, San Diego, 92103
    Affiliations
    Department of Medicine, University of California San Francisco, San Francisco, CA, United States
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  • R. Peter Lokken
    Affiliations
    Department of Radiology, Division of Interventional Radiology, University of California San Francisco, San Francisco, CA, United States
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  • Sanjay Kakar
    Affiliations
    Department of Pathology, University of California San Francisco, San Francisco, CA, United States
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  • Joshua Grab
    Affiliations
    Department of Medicine, UCSF Liver Center, University of California San Francisco, San Francisco, CA, United States
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  • Neil Mehta
    Affiliations
    Department of Medicine, UCSF Liver Center, University of California San Francisco, San Francisco, CA, United States

    Department of Medicine, Division of Gastroenterology/Hepatology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
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  • Monika Sarkar
    Correspondence
    Corresponding author.
    Affiliations
    Department of Medicine, UCSF Liver Center, University of California San Francisco, San Francisco, CA, United States

    Department of Medicine, Division of Gastroenterology/Hepatology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
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  • Author Footnotes
    1 Current affiliation: Department of Medicine, University of California San Diego, San Diego, 92103

      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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