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      Dual effects of a gonadotropin-releasing hormone agonist on an adolescent girl with pelvic congestion syndrome and precocious puberty: a case report

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          Abstract

          Pelvic congestion syndrome (PCS) typically causes chronic non-cyclical abdominal pain with a considerable negative effect on the quality of life of women. However, pediatric cases with PCS are limited and non-invasive therapy for adolescent patients has not been reported. We report here a 13-year-old girl who presented with intermittent abdominal pain since the age of 2 years and her symptoms further deteriorated after breast development at 6 years and 9 months old. PCS and coexistent idiopathic central precocious puberty were finally diagnosed on the basis of tortuous ovarian and pelvic veins, and a pubertal response to a gonadotropin-releasing hormone (GnRH) test without hypothalamic–pituitary lesions. After treatment with the GnRH agonist, the pain score was greatly reduced and there was increased prediction of adult height. This case highlights the occurrence of PCS in adolescents and also indicates the role of non-invasive GnRH agonists in young patients with PCS before surgical intervention.

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          Pronociceptive and antinociceptive effects of estradiol through endogenous opioid neurotransmission in women.

          Megan R Carey, Christian S Stohler, J BUELLER … (2006)
          Prominent interindividual and sex-dependent differences have been described in responses to sustained pain and other stressful stimuli. Variations in mu-opioid receptor-mediated endogenous opioid neurotransmission may underlie some of these processes. We examined both baseline mu-opioid receptor levels and the activation of this neurotransmitter system during sustained pain using positron emission tomography in a sample of young healthy men and women. Women were studied twice, during low and high estrogen states. The high-estrogen state was associated with regional increases in baseline mu-opioid receptor availability in vivo and a greater activation of endogenous opioid neurotransmission during the pain stressor. The latter did not differ from that obtained in males. During the low estrogen condition, however, significant reductions in endogenous opioid tone were observed at the level of thalamus, nucleus accumbens, and amygdala, which were associated with hyperalgesic responses. Estrogen-associated variations in the activity of mu-opioid neurotransmission correlated with individual ratings of the sensory and affective perceptions of the pain and the subsequent recall of that experience. These data demonstrate a significant role of estrogen in modulating endogenous opioid neurotransmission and associated psychophysical responses to a pain stressor in humans.
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            Pelvic congestion syndrome: etiology of pain, diagnosis, and clinical management.

            Darci Phillips, Amy Deipolyi, Richard Hesketh … (2014)
            Pelvic congestion syndrome is associated with pelvic varicosities that result in chronic pelvic pain, especially in the setting of prolonged standing, coitus, menstruation, and pregnancy. Although the underlying pathophysiology of pelvic congestion syndrome is unclear, it probably results from a combination of dysfunctional venous valves, retrograde blood flow, venous hypertension, and dilatation. Asymptomatic women may also have pelvic varicosities, making pelvic congestion syndrome difficult to diagnose. This article explores the etiologies of pain, use of imaging techniques, and clinical management of pelvic congestion syndrome. Possible explanations for the spectrum of pain among women with pelvic varicosities are also discussed.
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              Ovarian hormones and chronic pain: A comprehensive review.

              Samah Hassan, Abi Muere, Gillian Einstein (2014)
              Most chronic noncancer pain (CNCP) conditions are more common in women and have been reported to worsen, particularly during the peak reproductive years. This phenomenon suggests that ovarian hormones might play a role in modulating CNCP pain. To this end, we reviewed human literature aiming to assess the potential role of ovarian hormones in modulating the following CNCP conditions: musculoskeletal pain, migraine headache, temporal mandibular disorder, and pelvic pain. We found 50 relevant clinical studies, the majority of which demonstrated a correlation between hormone changes or treatments and pain intensity, threshold, or symptoms. Taken together, the findings suggest that changes in hormonal levels may well play a role in modulating the severity of CNCP conditions. However, the lack of consistency in study design, methodology, and interpretation of menstrual cycle phases impedes comparison between the studies. Thus, while the literature is highly suggestive of the role of ovarian hormones in modulating CNCP conditions, serious confounds impede a definitive understanding for most conditions except menstrual migraine and endometriosis. It may be that these inconsistencies and the resulting lack of clarity have contributed to the failure of hormonal effects being translated into medical practice for treatment of CNCP conditions. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Int Med Res
                Journal ID (iso-abbrev): J. Int. Med. Res
                Journal ID (publisher-id): IMR
                Journal ID (hwp): spimr
                Title: The Journal of International Medical Research
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 0300-0605
                ISSN (Electronic): 1473-2300
                Publication date (Electronic): 23 September 2020
                Publication date Collection: September 2020
                Volume: 48
                Issue: 9
                Electronic Location Identifier: 0300060520954694
                Affiliations
                [1 ]Department of Surgery, Taipei Veterans General Hospital, Taipei
                [2 ]Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei
                [3 ]Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei
                [4 ]Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei
                [5 ]Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei
                Author notes
                [*]Chien-Ming Lin, Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, R.O.C. Email: ming.sandra@ 123456msa.hinet.net
                Author information
                https://orcid.org/0000-0001-9854-2681
                https://orcid.org/0000-0001-7525-5743
                Article
                Publisher ID: 10.1177_0300060520954694
                DOI: 10.1177/0300060520954694
                PMC ID: 7521058
                PubMed ID: 32967508
                SO-VID: aaa87392-a6c3-40c3-85ff-f69b38e75c44
                Copyright © © The Author(s) 2020
                License:

                Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 5 May 2020
                Date accepted : 6 August 2020
                Funding
                Funded by: Tri-Service General Hospital, FundRef https://doi.org/10.13039/501100010425;
                Award ID: TSGH-E-109204
                Categories
                Subject: Case Report
                Custom metadata
                typesetter ts2

                Keywords: pelvic congestion syndrome,chronic abdominal pain,precocious puberty,adolescent,gonadotropin-releasing hormone agonist,predicted adult height,estrogen
                Data availability:
                Keywords: pelvic congestion syndrome, chronic abdominal pain, precocious puberty, adolescent, gonadotropin-releasing hormone agonist, predicted adult height, estrogen

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