Hormonell bedingte gynäkologische Krankheitsbilder im Kindes- und Jugendalter

ZUSAMMENFASSUNG

Blutungsstörungen bei Adoleszentinnen zählen zu den häufigsten Vorstellungsgründen in der kinder- und jugendgynäkologischen Sprechstunde [4], [5]. Sie gehören wie zahleiche weitere Pathologien zu den hormonell bedingten gynäkologischen Krankheitsbildern im Kindes- und Jugendalter. Da eine abnorme uterine Blutung (AUB) häufig auf die Unreife der Hypothalamus-Hypophysen-Ovar-Achse zurückzuführen ist, erreichen hormonelle eher als nicht-hormonelle Therapien gute Erfolge, um die Zeit bis zur vollständigen Ausreifung dieser Achse zu überbrücken [11]. Differenzialdiagnosen müssen immer mitbetrachtet werden. Bei den selteneren Krankheitsbildern, wie der Pubertas praecox und der Pubertas tarda und auch beim häufig auftretendem polyzystischen Ovarsyndrom, bedarf es einer umfangreichen Abklärung.

ABSTRACT

Bleeding disorders in adolescents are among the most common reasons for presentations in pediatric and adolescent gynecological consultations [4], [5]. Like numerous other pathologies, they belong to the group of hormone-related gynecological diseases in childhood and adolescence. Since abnormal uterine bleeding (AUB) often refers to the immaturity of the hypothalamic-pituitary-ovarian axis, hormonal therapies and non-hormonal therapies are effective in bridging the time mandatory for full maturation for this axis [11]. Differential diagnoses must always be taken into account. Extensive clarification is required for the rarer clinical pictures such as precocious puberty and late puberty, and also for the frequently occurring polycystic ovary syndrome.

Schlüsselwörter

Pubertät - abnorme uterine Blutung (AUB) - Adoleszenz - Gerinnungsstörung - Menstruationszyklus

Puberty - abnormal uterine bleeding (AUB) - adolescents - coagulation disorder - menstrual cycle

Publication History

Article published online:
01 December 2023

• Literatur

• 1 Teilmann G, Pedersen CB, Jensen TK. et al Prevalence and incidence of precocious pubertal development in Denmark: an epidemiologic study based on national registries. Pediatrics 2005; 116: 1323
• 2 Bourguignon J-P, Juul A. Normal Female Puberty in a Developmental Perspective. Endocrine Development 2012; 22: 11-23
• 3 Holzer I.. Die abnorme uterine Blutung in der Adoleszenz,. J Gynäkol Endokrinol AT 2020; 30: 33-34
• 4 Bennett AR, Gray SH. What to do when she’s bleeding through: the recognation, evaluation, and management of abnormal uterine bleeding in adolescents. Curr Opin Pediatr 2014; 26: 413-419
• 5 Parker MA, Sneddon AE, Arbon P. The menstrual disorderof teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population-based staudy of Australian teenagers. BJOG 2010; 177: 185-192
• 6 Kahl H, Schaffrath Rosario A, Schlaud M. Robert Koch-Institut. Sexuelle Reifung von Kinder und Jugendlichen in Deutschland, Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 2007. Springer Medizin Verlag 2007; 50: 677-685
• 7 Pinkney J, Streeter A, Hosking J. et al Adiposity, chronic inflammation, and the prepubertal decline of sex hormone binding globulin in children: evidence for associations withthe timing of puberty. J Clin Endocrinol Metab 2014; 99: 3224-3232
• 8 Aerts EG, Harlow K, Griesgraber MJ. et al Kisspeptin, Neurokinin B, and Dynorphin Expression during Pubertal Development in Female Sheep. Biology (Basel) 2021; 10 (10) 988
• 9 Sanchez J, Andrabi S, Bercaw JL, Dietrich JE. Quantifying the PBAC in a pediatric and adolescent gynecology population. Pediatr Hematol Oncol 2012; 29: 479
• 10 ACOG Committee Opinion No. 651. Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign. Obstet Gynecol 2015; 126 (06) e143-146
• 11 De Silva NK.. Abnormal uterine bleeding in adolescents: Evaluation and approach to diagnosis. UptoDate 2023
• 12 Chumlea WC, Schubert CM, Roche AF. et al Age at menarche and racial comparisons in US girls. Pediatrics 2003; 111: 110-113
• 13 Finer LB, Philbin JM. Trends in ages at key reproductive transitions in the United States, 1951–2010 Womens. Health Issues 2014; 24: e271-279
• 14 Schoelwer M, Eugster EA. Treatment of Peripheral Precocious Puberty. Endocr Dev 2016; 29: 230-239
• 15 Trotman Gylynthia E. Delayed puberty in the female patient. Current Opinion in Obstetrics and Gynecology 2016; 28 (05) 366-372
• 16 Harrington J, Palmert MR. Clinical review: Distinguishing constitutional delay of growth and puberty from isolated hypogonadotropic hypogonadism: critical appraisal of available diagnostic tests. J Clin Endocrinol Metab 2012; 97 (09) 3056-3067
• 17 Klein DA, Poth MA. Amenorrhea: an approach to diagnosis and management. Am Fam Physician 2013; 87 (11) 781-788
• 18 Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in girls. Arch Dis Child 1969; 44: 291-303
• 19 Hauffa BP, Simic-Schleicher G, Schnabel D.. Pubertas tarda und Hypogonadismus, Leitlinie der Deutschen Gesellschaft für Kinderendokrinologie und -diabetologie (DGKED). Version 11/2021 AWMF-Register Nr. 174–022Klasse: S1
• 20 American Academy of Pediatrics, Committee on Adolescence, American College of Obstetricians and Gynecologists and Committee on Adolescent Health Care Menstruation in Girls and Adolescents: Using the Menstrual as a Vital sign. Pediatrics 2006; 118 (05) 2245-2250
• 21 Rosenfield RL. Perspectives on the International Recommendations for the Diagnosis and Treatment of Polycystic Ovary Syndrome in Adolescence. J Pediatr Adolesc Gynecol 2020; 33: 445-447
• 22 Peña A, Codner E, Witchel S. Criteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review. Diagnostics 2022; 12: 1931
• 23 Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome Fertility and Sterility. 2004; 81 (01) 19-25
• 24 Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 2011; 113 (01) 3-13
• 25 Oppelt PG, Lehmann-Kannt S. Hrsg FAQ Kinder- und Jugendgynäkologie. 1. Aufl. Berlin: Elsevier; 2023
• 26 Delifeoroglou E, Karountzos V, Creatsas G. Abnormal uterine bleeding and dysfunctional uterine bleeding in pediatric and adolescent gynecology. Gynecol Endocrinol 2013; 29 (01) 74-77
• 27 Goeckenjan M, Gabrys M.. Zyklusstörungen im Jugendalter. Fachzeitschrift für Kinder- und Jugendgynäkologie – Mitteilungsblatt der Arbeitsgemeinschaft Kinder- und Jugendgynäkologie e. V. 35. Jahrgang, Dez 2020
• 28 Hoffmann D. Blutungsstörungen in der Adoleszenz. Schweizer Zeitschrift für Gynäkologie 2015; 05: 6-10
• 29 Durlinger AL, Kramer P, Karels B. et al Control of primordial follicle recruitment by anti-Müllerian hormone in the mouse ovary. Endocrinology 1999; 140 (12) 5789-5796
• 30 Levy-Zauberman Y, Pourcelot A, Capmas P, Fernandez H. Update on the management of abnormal uterine bleeding. J Gynecol Obstet and Human Reproduction 2021; 46 (08) 613-622
• 31 Mørch LS. et al Contemporary Hormonal Contraception and the Risk of Breast Cancer. N Engl J Med 2017; 77 (23) 2228-2239