Leuprolide acetate treatment of catamenial pneumothorax

A 35-year-old nulligravid female with a 20 pack year history of smoking and continuous OC use since age 16 presented with recurrent pneumothoraces coinciding with the onset of menses at age 28. At that time she underwent a right partial pleurectomy and lobectomy, which demonstrated bullous disease but no glandular or stromal elements. Although catamenial respiratory discomfort persisted while on OCs, no pneumothoraces were documented until age 33 at which time she was given the diagnosis of catamenial pneumothorax. A diagnostic laparoscopy failed to demonstrate endometriosis or the presence of diaphragmatic defects. In an effort to preserve her fertility, she began a course of LA-GnRH-a therapy with depot LA. Because of disabling vasomotor and emotional side effects, continuous conjugated estrogens and MPA acetate were given as add-back therapy. She has remained symptom and side effect free for over 2 years on this regimen.