Pregnancy and delivery after arterial embolization for fibroid treatment

PURPOSE: To analyze gestation evolution and deliveries after myoma treatment by embolization of the uterine arteries. METHODS: In the initial evaluation, 112 patients submitted to embolization of uterine arteries were included for treatment of myoma. From those, only nine wanted to be submitted to conservative treatment in order to keep their reproductive capacity. This procedure was indicated to the nine patients, since they were not susceptible to a conservative surgical treatment. They were submitted to embolization of the uterine arteries with particles of polyvinyl alcohol or embospheres with diameters ranging from 500 to 700 µm, and they have evolved without intercurrence. RESULTS: During the follow-up of these patients, there was a good clinical response with significant reduction in the uterus and myoma volumes. Four of them got pregnant, two had an early abortion and two evolved normally till the end of gestation with a term delivery. One of these had twins. CONCLUSION: Embolization of the uterine arteries is an option for the treatment of uterine myoma, and presents good clinical and anatomical results, allowing patients to preserve their reproductive capacity.OBJETIVO: Analisar a evolução da gestação e partos após tratamento de leiomioma uterino por embolização das artérias uterinas. MÉTODOS: Foram incluídas na avaliação inicial 112 pacientes submetidas a embolização de artérias uterinas para tratamento de mioma uterino. Destas, somente nove desejavam o tratamento conservador para manter a capacidade reprodutiva. Este procedimento foi indicado para estas nove pacientes, pois elas não eram susceptíveis ao tratamento conservador cirúrgico. Submeteram-se a embolização das artérias uterinas com partículas de álcool polivinílico ou embosferas com diâmetro de 500 a 700 µm e evoluíram sem intercorrências. RESULTADOS: Durante o acompanhamento dessas nove pacientes houve boa resposta clínica, com redução significativa no volume do útero e dos miomas. Dessas nove, quatro engravidaram, sendo que duas tiveram abortamento precoce e duas evoluíram normalmente até o final da gestação com parto a termo, sendo um deles gemelar. CONCLUSÃO: A embolização de artérias uterinas é uma opção para o tratamento de miomas uterinos e apresenta bons resultados clínicos e anatômicos, permitindo manter a capacidade reprodutiva.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de GinecologiaHospital Sírio LibanêsUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de ImagemHospital Sírio Libanês Departamento de Radiologia VascularUNIFESP, EPM, Depto. de GinecologiaUNIFESP, EPM, Depto. de ImagemSciEL

The ACTH test in the diagnosis of hirsutism

The ACTH test has been used to confirm the diagnosis of adrenal insufficiency and the classic and the non-classic adrenal hyperplasia due to the 3-HSD, 21 OH e 110H deficiencies. This article reviews the historical aspects of the use of ACTH in the diagnosis of hirsutism and points out its mains indications. In spite of new biological molecular advances in the diagnosis of adrenal enzymatic deficiencies, the use of the ACTH test can help the physician to predict both genothipus and fenothipus in populations with hyperandrogenic manifestations due to non-classical or late-onset congenital adrenal hyperplasia