leuprolide and Pneumothorax

Catamenial pneumothorax is a rare but serious condition for women of reproductive age. We describe a trial of dienogest as hormonal therapy for catamenial pneumothorax and review the literature on hormonal suppressive therapy for this condition.. A 39-year-old female, gravida 0 para 0, presented with recurrent pneumothoraces coinciding with her menses. After surgical therapy, she was started on leuprolide acetate injections for 6 months to reduce recurrence. To reduce long-term side effects of leuprolide acetate, the patient was started on dienogest 4 mg orally once daily instead of leuprolide acetate for hormonal suppression and experienced resolution of recurrent pneumothoraces.. For women with recurrent catamenial pneumothorax, dienogest may be an effective hormonal treatment option and alternative to long-term GnRH agonist therapy for long-term suppression.

Topics: Adult; Female; Hormone Antagonists; Humans; Leuprolide; Nandrolone; Pneumothorax

Thoracic endometriosis is a rare disease, which presents in women at a mean age of 35 years, later than for pelvic endometriosis. There are no known predisposing factors for the condition and its pathogenesis is not yet clearly established. The symptoms always appear in connection with the periods of the person affected by the condition, occurring within 24-48 h after the start of menstruation. Catamenial pneumothorax is the most common clinical entity. It is associated with pelvic endometriosis in 30-50% of cases. Thoracoscopy, preferably performed during menstruation, allows full inspection of the diaphragm and the pleural cavity for defects in the diaphragm, endometrial nodules and bullae. The level of CA 125 is often elevated but this is not a reliable or specific marker. Medical treatment is aimed at blocking the action of estrogen on the endometrium and ectopic endometrial implants. GnRH analogues or danazol are the preferred treatments. Surgery to repair and strengthen the diaphragm and/or resect nodules or bullae also has a role, supplemented by pleurodesis to prevent further pneumothorax or effusions. The main risk is recurrence, and thus the current usual practice is to combine surgery, immediately followed by hormone therapy focusing on GnRH analogues.

Topics: Adult; alpha 1-Antitrypsin Deficiency; Biomarkers; CA-125 Antigen; Combined Modality Therapy; Danazol; Diagnosis, Differential; Endometriosis; Estrogen Receptor Modulators; Female; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Middle Aged; Pneumothorax; Pulmonary Emphysema; Recurrence; Thoracic Diseases; Thoracic Surgery, Video-Assisted; Thoracoscopy

Topics: Antineoplastic Agents, Hormonal; Bronchodilator Agents; Chylothorax; Gonadotropin-Releasing Hormone; Goserelin; Humans; Leuprolide; Lung Neoplasms; Lung Transplantation; Lymphangioleiomyomatosis; Ovariectomy; Pneumothorax; Progesterone; Respiratory Insufficiency

Topics: Antineoplastic Agents, Hormonal; Female; Hemangioma, Capillary; Hemoptysis; Humans; Leuprolide; Lung; Menstruation; Pneumothorax; Recurrence; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed; Young Adult

A patient with diaphragmatic endometriosis who showed immediate relapse following radical thoracoscopic surgery received personalized GnRH agonist (GnRHa) therapy. GnRHa depots were subcutaneously injected by modulating injection intervals according to serum estradiol and LH levels in order to maintain long-term amenorrhea without any adverse effects. A leuprolide acetate depot was injected 24 times for 34 months. Therefore, so far, 1.88 mg of leuprolide acetate depot have been injected every seven weeks to achieve a stable endocrine condition with 15-30 pg/ml serum estradiol, 3-10 IU/l serum LH, and 7-15 IU/lI serum FSH.

Topics: Adult; Diaphragm; Endometriosis; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Humans; Injections, Subcutaneous; Leuprolide; Menstrual Cycle; Pneumothorax

Catamenial pneumothorax is a rare clinical entity of unknown etiology. The most well known hypothesis is passage of air from the genital tract through endometrial fenestrations in the diaphragm. Although some reports are associated with diaphragmatic endometriosis, few have been confirmed endometrial implants in the visceral pleura. We describe a very rare case of catamenial pneumothorax caused by ectopic endometriosis in the visceral pleura confirmed histopathologically in a woman 1-year after hysterectomy.

Topics: Adult; Endometriosis; Female; Follow-Up Studies; Humans; Hysterectomy; Immunohistochemistry; Leiomyoma; Leuprolide; Periodicity; Pleural Diseases; Pneumothorax; Rare Diseases; Recurrence; Thoracoscopy; Treatment Outcome; Uterine Neoplasms

We reported a case of catamenial pneumothorax that was recurrent after surgical treatment. A 43-year-old woman had sudden chest pain and dyspnea during menstruation. Right pneumothorax and pleural effusion were pointed out on chest X-ray films. When the patient was 31 years old, she received a diagnosis of catamenial pneumothorax and underwent thoracotomy for resection of diaphragmatic endometriosis. However, after surgery she experienced recurrence of right pneumothorax, and was accordingly treated with danazol. The patient decided to terminate medication by herself because her symptoms had disappeared. Several years after the cessation of medication, she experienced chest pain frequently during menstruation, but did not seek a medical check-up. She visited our department because of persistent chest pain in 1997. After the patient was hospitalized, pneumothorax was diagnosed and continuous drainage was performed. Although pneumothorax was alleviated by drainage, it recurred during the patient's next menstrual period. Open lung surgery was performed. Diaphragmatic endometriosis with a small hole and inflammatory thickened lesions on the visceral pleura of the lower lobe (S 6) were found and excised. Microscopic examination of the excised specimens showed endometriosis. Visceral pleural endometriosis has been histologically demonstrated in very few cases. After surgery, hormonal therapy was started. The patient has been well for 12 months without recurrence of pneumothorax. Both surgical and hormonal treatment were considered necessary for the treatment of catamenial pneumothorax in this case.

Topics: Combined Modality Therapy; Diaphragm; Endometriosis; Female; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Menstruation; Middle Aged; Muscular Diseases; Pleural Diseases; Pneumothorax; Recurrence; Treatment Outcome

A 30-year-old female had twice experienced right pneumothorax within 2 months that was related to the onset of menstruation, suggesting catamenial pneumothorax. Right thoracoscopy revealed the presence of "blue berry spots" and pinhole at the lateral part of central tendon in the diaphragm. No bulla or bleb was found on the right lung. Partial resection of the diaphragm including these lesions was performed under small thoracotomy assisted by thoracoscopy. Histological findings showed endometriosis of the diaphragm. She was followed without hormonal therapy, but recurrent right pneumothorax occurred. Therefore she was given leuprorelin acetate for 5 months, and she is asymptomatic 7 months after surgery.

Topics: Adult; Diaphragm; Endometriosis; Endoscopy; Female; Fertility Agents, Female; Humans; Leuprolide; Menstruation; Muscular Diseases; Pneumothorax; Recurrence; Thoracoscopy; Thoracotomy

Catamenial pneumothorax, or monthly recurring pneumothorax associated with menstruation, has been reported with increasing frequency in recent years. A representative case illustrates the clinical syndrome, particularly the intraoperative findings. Characteristic of this disorder are a peak incidence in the late twenties or early thirties, recurrent right-sided pneumothoraces occurring at the onset of menstruation, and an association with pelvic endometriosis. Pathologically, there is a consistent pattern of intrathoracic, especially diaphragmatic, foci of ectopic endometrial tissue. There is also a strong association with diaphragmatic fenestrations, though their significance is controversial. Traditional therapy has involved treatment with estrogens, danazol, or thoracotomy with mechanical pleurodesis. These methods have proven, through a large meta-analysis, to be associated with a relatively high rate of recurrence. Subsequent advances in hormonal therapy, along with the development of minimal access surgery, have led to an evolution in management. Despite uncertainty as to the etiology of catamenial pneumothorax, diagnosis of the condition is straightforward and modern treatment is successful in preventing recurrence.

Topics: Adult; Biopsy, Needle; Drainage; Drug Administration Schedule; Female; Fertility Agents, Female; Follow-Up Studies; Humans; Injections, Intramuscular; Leuprolide; Menstruation Disturbances; Pleurodesis; Pneumothorax; Recurrence; Tomography, X-Ray Computed; Treatment Outcome

A 35-year-old nulligravid female with a 20 pack year history of smoking and continuous OC use since age 16 presented with recurrent pneumothoraces coinciding with the onset of menses at age 28. At that time she underwent a right partial pleurectomy and lobectomy, which demonstrated bullous disease but no glandular or stromal elements. Although catamenial respiratory discomfort persisted while on OCs, no pneumothoraces were documented until age 33 at which time she was given the diagnosis of catamenial pneumothorax. A diagnostic laparoscopy failed to demonstrate endometriosis or the presence of diaphragmatic defects. In an effort to preserve her fertility, she began a course of LA-GnRH-a therapy with depot LA. Because of disabling vasomotor and emotional side effects, continuous conjugated estrogens and MPA acetate were given as add-back therapy. She has remained symptom and side effect free for over 2 years on this regimen.

Topics: Adult; Contraceptives, Oral; Delayed-Action Preparations; Female; Follow-Up Studies; Humans; Leuprolide; Lung; Menstruation; Pleura; Pneumothorax; Recurrence; Smoking; Syndrome; Treatment Failure

Catamenial pneumothorax, a rare complication of systemic endometriosis, has been difficult to treat successfully. Successful medical therapy is associated with amenorrhea.. A 44-year-old white woman with recurring catamenial pneumothorax underwent thoracotomy and abrasive pleurodesis. Following the procedures, pneumothorax occurred again and she was treated with the GnRH analogue leuprolide acetate, 3.75 mg monthly intramuscularly. After 6 months, her therapy was changed to continuous hormonal suppression with norethindrone, 0.7 mg/day. After 6 months of this therapy and into the third episode of vaginal bleeding, the patient had another recurrent pneumothorax.. Leuprolide acetate followed by continuous hormonal suppression with norethindrone was successful for 1 year in resolving recurring postsurgical catamenial pneumothorax, but the problem recurred with the resumption of vaginal bleeding during progestin therapy. Successful medical therapy requires amenorrhea.

Topics: Adult; Female; Humans; Leuprolide; Menstruation; Pleura; Pneumothorax; Recurrence

The lung is an infrequent location of extragenital endometriosis, an exceptional cause of hemoptysis or pneumothorax. Adequate management has not yet been well established. We present two cases of pulmonary endometriosis, parenchymal and pleural. The presenting symptoms were catamenial hemoptysis and pneumothorax, respectively, which were treated with GnRH analogues. The first patient received Buserelin (900 micrograms/day intranasally) for 6 months. After 15 months of normal menstrual activity, the symptoms reappeared. The patient was then treated with Triptorelin (3.75 mg/month intramuscularly) for 6 months and remains asymptomatic and menstruating 14 months after discontinuing treatment. The patient presenting with pneumothorax was treated with leuprolide (1 mg/day subcutaneously) for 6 months and is asymptomatic 1 year after stopping treatment. These results suggest that GnRH analogues may be an acceptable alternative to danazol in the medical management of pulmonary endometriosis.

Topics: Administration, Intranasal; Adult; Antineoplastic Agents; Buserelin; Endometriosis; Female; Gonadotropin-Releasing Hormone; Hemoptysis; Hormones; Humans; Leuprolide; Lung Neoplasms; Pneumothorax; Triptorelin Pamoate