Endometrioza u adolescentica

master's thesis

• Title (english): Endometriosis in adolescents
• Author: Denis Kašljević
• Mentor: Mario Ćorić (mentor)
• Committee member: Dinka Pavičić Baldani (predsjednik povjerenstva)
• Committee member: Željko Duić (član povjerenstva)
• Committee member: Mario Ćorić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Endometrioza je kronična i o estrogenu ovisna ginekološka bolest koja se javlja u adolescentnoj populaciji i u žena reproduktivne dobi. Karakterizira je prisustvo funkcionalnog endometriotičkog tkiva izvan maternice, najčešće u području zdjelice. Točan mehanizam nastanka i održavanja ove bolesti nije u potpunosti jasan iako se zna kako centralnu ulogu igra estrogen, točnije estradiol. Procjenjuje se kako prevalencija endometrioze u žena reproduktivne dobi iznosi oko 10 %, dok su ti podaci za adolescentice uglavnom nepoznati. Klasični simptomi endometrioze jesu zdjelična bol i neplodnost. Endometrioza u adolescentica smatra se posebnom varijantom endometrioze jer postoje dokazi o tome kako bolest u ovoj populaciji ima tendenciju progresije ka težim oblicima. Jedno od glavnih obilježja za ovu populaciju je i kasno postavljanje dijagnoze zbog često nespecifičnih simptoma i loše osviještenosti o ovoj bolesti među liječnicima primarne zdravstvene zaštite. Bol se prvenstveno prezentira u obliku kronične zdjelične boli i dismenoreje. Neplodnost kao simptom u adolescentica uglavnom izostaje zbog mlade dobi te je stoga fokus prvenstveno na očuvanju plodnosti za kasniji život. Endometrioza ima negativan utjecaj na kvalitetu života te adolescentice koje boluju od ove bolesti često pate od anksioznosti i/ili depresije. Dijagnostički proces započinje detaljno uzetom anamnezom i ciljanim fizikalnim pregledom. U slučaju postojanja sumnje na endometriozu sljedeća pretraga kojom se najčešće koristimo jest transvaginalni ultrazvuk (TVUZ). Magnetska rezonanca (MR) druga je slikovna pretraga kojom se također možemo koristiti u dijagnostici endometrioze i to najčešće kao druga linija, odnosno nakon ultrazvuka. Kao zlatni standard u dijagnostici endometrioze i danas ostaje laparoskopija jer ona jedina omogućuje izravnu vizualizaciju lezija i histološku analizu sumnjivog tkiva. U liječenju endometrioze u adolescentica koristimo se farmakološkim liječenjem, kirurškim intervencijama i tehnikama potpomognute oplodnje (ART). Nažalost, većina terapijskih smjernica za liječenje adolescente endometrioze bazirana je na studijama provedenim na ženama reproduktivne dobi. Liječenje se stoga mora prilagoditi svakoj pacijentici ovisno o dominantnoj simptomatologiji i stadiju bolesti.

Abstract (english)

Endometriosis is a chronic and estrogen-dependent gynecological disease that occurs in the adolescent population and in women of reproductive age. It is characterized by the presence of functional endometriotic tissue outside the uterus, most commonly in the pelvic area. The exact mechanism of origin and maintenance of this disease is not completely clear, although it is known that estrogen, more precisely estradiol, plays a central role. The prevalence of endometriosis in women of reproductive age is estimated to be about 10%, while these data for adolescent girls are generally unknown. The classic symptoms of endometriosis are pelvic pain and infertility. Endometriosis in adolescents is considered a special variant of endometriosis because there is evidence that the disease in this population tends to progress to more severe forms. One of the main features of this population is also late diagnosis due to often nonspecific symptoms and poor awareness of this disease among primary care physicians. The pain is primarily presented in the form of chronic pelvic pain and dysmenorrhea. Infertility as a symptom in adolescents is mostly absent due to the young age and therefore the focus is primarily on preserving fertility for later life. Endometriosis has a negative impact on the quality of life and adolescents suffering from this disease often suffer from anxiety and/or depression. The diagnostic process begins with a detailed history and targeted physical examination. If endometriosis is suspected, the next test we use most often is transvaginal ultrasound (TVUS). Magnetic resonance imaging (MRI) is another imaging test that can also be used in the diagnosis of endometriosis, most often as a second line, that is after the ultrasound. Laparoscopy remains the gold standard in the diagnosis of endometriosis today because it is the only procedure that allows direct visualization of lesions and histological analysis of suspicious tissue. In the treatment of endometriosis in adolescents, we use pharmacological treatment, surgical interventions and assisted reproductive techniques (ART). Unfortunately, most therapeutic guidelines for treating adolescent endometriosis are based on studies conducted on women of reproductive age. Treatment must therefore be tailored to each patient depending on the dominant symptomatology and stage of the disease.

• Keywords: endometrioza; adolescentice; zdjelična bol; neplodnost
• Keywords (english): endometriosis; adolescents; pelvic pain; infertility
• Language: croatian
• URN:NBN: urn:nbn:hr:105:041033
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-13 08:42:21