Ann Pediatr Endocrinol Metab.  2014 Sep;19(3):135-140. 10.6065/apem.2014.19.3.135.

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

• Lee JW
• Kim HJ
• Choe YM
• Kang HS
• Kim SK
• Jun YH
• Lee JE

• KMID: 2134080
• DOI: http://doi.org/10.6065/apem.2014.19.3.135

Abstract

PURPOSE
Long-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.
METHODS
This 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.
RESULTS
Six 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.
CONCLUSION
Sterile 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.

Keyword

Drug-related side effects and adverse reactions; Central precocious puberty; Leuprolide; Triptorelin

MeSH Terms

Abscess
Adolescent
Ambulatory Care Facilities
Anaphylaxis
Child
Drug-Related Side Effects and Adverse Reactions
Gonadotropin-Releasing Hormone*
Humans
Korea
Leuprolide
Pediatrics
Prevalence
Puberty*
Puberty, Precocious*
Retrospective Studies
Slipped Capital Femoral Epiphyses
Triptorelin Pamoate
Gonadotropin-Releasing Hormone
Leuprolide
Triptorelin Pamoate

Figure

• 

  Fig. 1 Leuprolide acetate depot was subcutaneously injected into the upper arm of a 7.6-year- old girl at four-week interval. A sterile abscess was formed at the injection site after the 7th injection.

• 

  Fig. 2 Leuprolide acetate depot was subcutaneously injected into the arm of a 9-year-old girl at four-week interval. (A) A sterile abscess was formed at the injection site after the 5th injection. (B) The treatment was switched to triptorelin depot, which intramuscularly injected into her buttock, but a sterile abscess and pus formed 3 weeks after the first injection. (C) The lesion on the buttock healed with scarring 10 weeks later.

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