Gonadotropin-Releasing Hormone agonist Use in Adolescents with Uterine Leiomyomas

1.1. Background: Uterine smooth muscle tumors are rare in adolescents (<21 years of age). This case report and review of literature discusses the use of Gonadotropin-Releasing Hormone (GNRH) analogues in adolescent patients with leiomyoma. 1.2. Case: A 14-year-old female presented with lower back pain and a uterine mass. MRI demonstrated a 10 cm mass arising from the anterior uterine wall, diagnosed by biopsy as a probable leiomyoma. She was treated with two doses of depot Lupron (a GNRH analogue), but this failed to decrease the mass. Incidentally, the patient was born with a meningomyelocele and as a result, had urinary incontinence and difficulty with ambulation. Options were discussed with the family and patient. Removing the mass would have removed the anterior wall of the uterus and closure was not believed possible. Furthermore, the mass failing to respond to the GNRH analogue made the diagnosis of a benign mass questionable. At the family’s request, the patient underwent a hysterectomy; final pathology was consistent uterine leiomyoma. 1.3. Conclusion: This case and a review of the literature finds that response of uterine leiomyoma in adolescent patients to GNRH agonists is variable. These leiomyomas may not be hormonally-sensitive or may have a pathological basis that is different from the more common leiomyoma in older women.