Congenital adrenal hyperplasia (CAH) is an inherited disorder of adrenal steroidogenesis often diagnosed in infancy. Gynecologists may encounter adult patients with CAH due to the clinical effects of increased androgens, e.g. hirsutism, clitoromegaly, oligomenorrhea, or, rarely, pelvic masses. This case report reviews the association of para-ovarian adrenal rest tumors with CAH, and the role of gynecologists in their evaluation and treatment. A 23-year-old woman with CAH (21-hydroxyase deficiency) untreated for the past 5 years presented with a pelvic mass and elevated serum testosterone (1433 ng/dL) and plasma ACTH (1117 pg/mL). Intraoperative findings revealed multiple retroperitoneal masses. Final pathology demonstrated adrenal rest tissue. Para-ovarian and ovarian adrenal rest tumors may present as a rare gynecologic manifestation in patients with untreated CAH.

Preoperative use of estrogen vaginally did not appear to mediate the risk of mesh exposure following midurethral sling placement in this cohort.

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Objective: Stenosis of the endocervical canal is a difficult challenge to overcome, when encountered at the time of hysteroscopy. Mechanical dilation of a stenotic cervix can potentially lead to damage to the wall of the endocervix, and creation of a passage within the cervical stroma. Creation of a false passage subsequently leads to obliteration of the endocervical canal, and often requires the surgeon to discontinue the procedure, or risk perforating the uterus in an area prone to bowel, bladder, ureteral, and vascular injury. The objective of the current study is to demonstrate a safe and effective method to enter the uterine cavity using hydrodilation. Design: A video demonstration. Settings: Minimally invasive gynecology center. Patients: N/A. Interventions:The following video demonstrates a safe and effective method to enter into the uterine cavity using hydrodilation, without the need for mechanical dilation of the cervix. A technique to overcome cervical stenosis and false passages will also be demonstrated, using hydrodilation and a hydrophilic guidewire. Measurements/Results: Results to be presented. Conclusions: Stenosis of the endocervical canal is a difficult challenge to overcome, when encountered at the time of hysteroscopy. Mechanical dilation of a stenotic cervix has the potential risk of perforation at the level of the cervix, and injury to the bowel, bladder, ureteral, and vasculature. When cervical stenosis or creation of a false passage does occur, the technique demonstrated using hysteroscopic hydrodilation and a hydrophilic guidewire is a safe and effective method to resolve these issues.