Abstract：
Endometriosis is often diagnosed in reproductive aged women with spontaneous ovarian activity. Here we described a case of endometriosis diagnosed in a patient with premature ovarian insufficiency (POI) due to prepubertal bone marrow transplant (BMT). The patient is a 22-year-old nulligravid female who presented with chronic pelvic pain. She had an inherited bone marrow failure syndrome (Diamond-Blackfan anemia), which required gonadotoxic chemotherapy for BMT at a young age prior to puberty. At age 13, she received hormone therapy with transdermal estrogen with subsequent addition of cyclic progestin and was later transitioned to combined oral contraceptive pills (COC). Endometriosis was suspected due to progressive dysmenorrhea and multiple cyclic systemic symptoms. She underwent a trial of elagolix, but could not tolerate it due to worsened arthralgia. Norethindrone acetate (NET-A) was then started, and she underwent diagnostic laparoscopy. Laparoscopy revealed scattered superficial endometriotic lesions in the pelvis. Histological studies showed florid endometriosis. Patient continues on NET-A 10mg and oral estradiol 0.5mg daily since the surgery and has experienced sustained improvement in her symptoms. Endometriosis should be considered as a possible cause for progressive dysmenorrhea or pelvic pain, even in the setting of POI. The balance between HT for overall health benefits in young women with POI and the risk of endometriosis exacerbation is delicate, but achievable.
摘要：
子宫内膜异位症通常在具有自发性卵巢活动的育龄女性中被诊断出来。在这里，我们描述了由于青春期前骨髓移植（BMT）而诊断为卵巢早衰（POI）的子宫内膜异位症的病例。患者是一名22岁的未妊娠女性，患有慢性盆腔疼痛。她患有遗传性骨髓衰竭综合征（Diamond-Blackfan贫血），在青春期之前需要对BMT进行性腺毒性化疗。13岁时，她接受了经皮雌激素的激素治疗，随后添加了环状孕激素，后来过渡到联合口服避孕药（COC）。由于进行性痛经和多个循环全身症状，怀疑子宫内膜异位症。她接受了Elagolix的审判,但由于关节痛加重而无法忍受。然后开始醋酸维酮酮（NET-A），她接受了诊断性腹腔镜检查。腹腔镜检查显示骨盆中分散的浅表子宫内膜异位病变。组织学研究显示花状子宫内膜异位症。自手术以来，患者继续每天服用NET-A10mg和口服雌二醇0.5mg，并且症状持续改善。子宫内膜异位症应被视为进行性痛经或盆腔疼痛的可能原因。即使在POI的设置。在患有POI的年轻女性中，HT对整体健康有益与子宫内膜异位症恶化的风险之间的平衡是微妙的，但可以实现。
