Agrawal Sungeeta, Gensure Robert, Milner Lawrence, Nicoletta Julie, Sadeghi-Nejad Abdollah
Division of Pediatric Endocrinology, Floating Hospital for Children, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
Division of Pediatric Nephrology, Floating Hospital for Children, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
Case Rep Pediatr. 2019 Apr 4;2019:1624274. doi: 10.1155/2019/1624274. eCollection 2019.
Glucocorticoids are typically prescribed for the treatment of idiopathic nephrotic syndrome of childhood. In selected patients with refractory focal segmental glomuerulosclerosis (FSGS), adrenocorticotropin (ACTH) can be used to induce remission and decrease the progression of the disease. We report a 6 8/12-year-old girl with recurrent proteinuria, resistant to standard immunotherapy. She underwent related renal transplant but again developed proteinuria and was started on ACTH. She subsequently developed peripheral precocious puberty (PPP), presumably from peripheral aromatization of adrenal androgens. She was started on an aromatase inhibitor, and her ACTH dose was slowly decreased. She then developed central precocious puberty (CPP). We hypothesize that treatment of her peripheral precocious puberty with an aromatase inhibitor may have triggered central precocious puberty.
糖皮质激素通常用于治疗儿童特发性肾病综合征。对于部分难治性局灶节段性肾小球硬化（FSGS）患者，促肾上腺皮质激素（ACTH）可用于诱导缓解并减缓疾病进展。我们报告了一名6又8/12岁的女孩，她反复出现蛋白尿，对标准免疫疗法耐药。她接受了相关肾移植，但再次出现蛋白尿，并开始使用ACTH治疗。随后她出现了外周性性早熟（PPP），推测是由于肾上腺雄激素在外周芳香化所致。她开始使用芳香化酶抑制剂，ACTH剂量逐渐减少。之后她又出现了中枢性性早熟（CPP）。我们推测用芳香化酶抑制剂治疗她的外周性性早熟可能引发了中枢性性早熟。
