Occurrence of Slipped Capital Femoral Epiphysis in Children Undergoing Gonadotropin-Releasing Hormone Agonist Therapy for the Treatment of Central Precocious Puberty

Inman, Mark D.; Hursh, Brenden E.; Mokashi, Arati; Pinto, Teresa; Metzger, Daniel L.; Cummings, Elizabeth A.

doi:10.1159/000351028

Cited by 11 publications

(16 citation statements)

References 13 publications

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“…Anaphylaxis is a serious allergic or hypersensitivity reaction that is rapid in onset and may cause life-threatening conditions 11) . SCFE is the displacement of the upper femoral epiphysis from the femoral metaphysis 10) .…”

Section: Methodsmentioning

confidence: 99%

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Significant adverse reactions to long-acting gonadotropin-releasing hormone agonists for the treatment of central precocious puberty and early onset puberty

Lee

Kim

Choe

et al. 2014

Ann Pediatr Endocrinol Metab

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PurposeLong-acting gonadotropin-releasing hormone agonists (GnRHa) are commonly used to treat central precocious puberty (CPP) in Korea. Although rare, there have been reports on the characteristic of adverse reactions of GnRHa in CPP among the Korean population. This study was intended to report on our clinical experience regarding significant adverse reactions to long-acting GnRHa in CPP and early onset puberty and to evaluate the prevalence rate of serious side effects.MethodsThis retrospective study included children with CPP and early onset puberty, who were administered monthly with long-acting GnRHa (leuprolide acetate, triptorelin acetate) at the outpatient clinic of Department of Pediatrics, at Inha University Hospital, between January 2011 and December 2013. We analyzed the clinical characteristics of patients who experienced significant adverse reactions and evaluated the prevalence rate.ResultsSix serious side effects (0.9%) were observed among total of 621 CPP and early onset puberty children with GnRHa therapy. The number of sterile abscess formation was four in three patients (4 events of 621). Anaphylaxis occurred in only one patient, and unilateral slipped capital femoral epiphysis (SCFE) in another one patient. Anaphylaxis occurred after the 6th administration of the monthly depot triptorelin acetate. Unilateral SCFE developed in GnRHa therapy.ConclusionSterile abscess formation occurred in 0.6% of CPP and early onset puberty patients from the administration of a monthly depot GnRHa therapy. The occurrences of anaphylaxis and SCFE are extremely rare, but can have serious implications on patients. Clinicians should be aware of these potential adverse effects related to GnRHa therapy in CPP.

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Section: Methodsmentioning

confidence: 99%

“…Meanwhile, anaphylaxis may rarely occur as a systemic side effect related to GnRHa administration. Recently, there have been reports indicating that administration of GnRHa may be a risk factor for the development of slipped capital femoral epiphysis (SCFE) 7 , 8 , 9 , 10) .…”

Section: Introductionmentioning

confidence: 99%

Significant adverse reactions to long-acting gonadotropin-releasing hormone agonists for the treatment of central precocious puberty and early onset puberty

Lee

Kim

Choe

et al. 2014

Ann Pediatr Endocrinol Metab

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“…Side effects include adverse skin reactions (sometimes requiring desensitization) in the absence of immunoglobulin G (IgG) antibodies toward the drug . An uncontrolled study has suggested that slipped capital femoral epiphysis can occur in children during therapy with GnRH‐agonists, a series that included one girl with HH . The efficacy of GnRH agonists to suppress puberty associated with HH is high .…”

Section: Treatmentmentioning

confidence: 99%

“…52 An uncontrolled study has suggested that slipped capital femoral epiphysis can occur in children during therapy with GnRH-agonists, a series that included one girl with HH. 53 The efficacy of GnRH agonists to suppress puberty associated with HH is high. 54 Failures are most often caused by medication intolerance, usually local injection site reactions, which have been reported to occur in 1-8% of patients.…”

Section: Premature Thelarche Adrenarche and Pubarchementioning

confidence: 99%

Hypothalamic hamartoma with epilepsy: Review of endocrine comorbidity

2017

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Summary The most common, and usually the only, endocrine disturbance in patients with hypothalamic hamartoma (HH) and epilepsy is central precocious puberty (CPP). The mechanism for CPP associated with HH may relate to ectopic generation and pulsatile release of gonadotropin-releasing hormone (GnRH) from the HH, but this remains an unproven hypothesis. Possible regulators of GnRH release that are intrinsic to HH tissue include the following: (1) glial factors (such as transforming growth factor α[TGFα) and (2) γ-aminobutyric acid (GABA)–mediated excitation. Both are known to be present in surgically-resected HH tissue, but are present in patients with and without a history of CPP, suggesting the possibility that symptoms related to HH are directly associated with the region of anatomic attachment of the HH to the hypothalamus, which determines functional network connections, rather than to differences in HH tissue expression or pathophysiology. CPP associated with HH presents with isosexual development prior to the age of 8 years in girls and 9 years in boys. It is not uncommon for CPP with HH to present in children at an earlier age in comparison to other causes of CPP, including in infancy. Surgical resection of the HH can be effective for treating CPP, but is reserved for patients with intractable epilepsy, since GnRH agonists are widely available and effective treatment. Other endocrine disturbances with HH are rare, but can include growth hormone deficiency, hypothyroidism, and adrenal insufficiency. Diabetes insipidus is commonly encountered postoperatively, but is not observed with HH prior to surgical intervention.

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“…Local effects of GnRH analogues including induration and aseptic abscess are generally well known. Rare adverse effects of the agents on the nervous system, skin, gastrointestinal tract, and cardiovascular system have also been reported (1)(2)(3)(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

A patient developing anaphylaxis and sensitivity to two different GnRH analogues and a review of literature

Ökdemir

Hatipoğlu

Akar

et al. 2015

Journal of Pediatric Endocrinology and Metabolism

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Gonadotropin-releasing hormone analogues are used in the treatment of prostate cancer, breast cancer, endometriosis, and uterine leiomyomas in adults and often in the treatment of precocious puberty in children. Many adverse effects have been reported for gonadotropin-releasing hormone analogues, but anaphylaxis is rarely reported as an adverse effect. Frequent cross-reactions, particularly during childhood, and diversity of the time of onset of anaphylactic manifestations complicate the diagnosis. A patient who exhibited anaphylactic allergic reactions to two different agents used in the treatment of central precocious puberty presented here because the case has an atypical course and is the first in the literature.

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Occurrence of Slipped Capital Femoral Epiphysis in Children Undergoing Gonadotropin-Releasing Hormone Agonist Therapy for the Treatment of Central Precocious Puberty

Cited by 11 publications

References 13 publications

Significant adverse reactions to long-acting gonadotropin-releasing hormone agonists for the treatment of central precocious puberty and early onset puberty

Significant adverse reactions to long-acting gonadotropin-releasing hormone agonists for the treatment of central precocious puberty and early onset puberty

Hypothalamic hamartoma with epilepsy: Review of endocrine comorbidity

A patient developing anaphylaxis and sensitivity to two different GnRH analogues and a review of literature

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