Steen Erica A, Phillips Susan A
University of California, San Diego, California, USA.
Rady Children's Hospital, University of California, San Diego, California, USA.
Endocrinol Diabetes Metab Case Rep. 2024 Aug 16;2024(3). doi: 10.1530/EDM-24-0031. Print 2024 Jul 1.
A 6.6-year-old female presented to endocrinology with precocious puberty for evaluation and management. Workup was initiated, and a diagnosis of central precocious puberty was confirmed. A decision was made to initiate pubertal blockade using gonadotropin-releasing hormone agonist (GnRHa) therapy with depot leuprolide acetate injections every 3 months. The patient received the first depot leuprolide acetate injection in the right ventrogluteal area. Six hours following the injection, the patient was reported to be inconsolable in pain, which was localized to the right hip site of the earlier injection and associated with a refusal to ambulate. The pain and discomfort continued to progress over the next 24 h despite an alternating regimen of Tylenol and ibuprofen prompting admission to the emergency department. Vital signs demonstrated a low-grade fever and elevated C-reactive protein. An ultrasound of the right hip demonstrated fluid accumulation within the joint. Over the next week, the patient was unable to walk independently and required assistance for activities of daily living. By 2 weeks after the injection, the pain began to remit, and the patient resumed activities of daily living. Following consultation with allergy, a decision was made to continue GnRHa suppressive therapy with an alternative analog (Triptodur). The patient tolerated subsequent treatment without reaction.
Although gonadotropin-releasing hormone agonists (GnRHa) have a generally good safety profile, there is a history of both local and systemic hypersensitivity reactions associated with their use. Despite the long-acting formulation of depot leuprolide acetate, the systemic reaction in this case appears to be self-limited. Discontinuation of therapy or a change to an alternative formulation of GnRHa analog should be considered based on the need for therapy versus the potential risk of rechallenge.
一名6.6岁女性因性早熟就诊于内分泌科进行评估和治疗。检查工作开始，确诊为中枢性性早熟。决定使用促性腺激素释放激素激动剂（GnRHa）疗法进行青春期阻断，每3个月注射一次长效醋酸亮丙瑞林。患者在右臀中肌区域接受了首次长效醋酸亮丙瑞林注射。注射后6小时，据报告患者疼痛难忍，疼痛局限于先前注射的右髋部位，并伴有拒绝行走。尽管交替使用对乙酰氨基酚和布洛芬，疼痛和不适在接下来的24小时内仍持续加重，促使患者入住急诊科。生命体征显示低热和C反应蛋白升高。右髋超声显示关节内有积液。在接下来的一周里，患者无法独立行走，日常生活活动需要帮助。注射后2周，疼痛开始缓解，患者恢复了日常生活活动。在咨询过敏科后，决定改用另一种类似物（曲普瑞林）继续GnRHa抑制治疗。患者耐受了后续治疗，未出现反应。
尽管促性腺激素释放激素激动剂（GnRHa）总体安全性良好，但使用过程中存在局部和全身过敏反应的病史。尽管长效醋酸亮丙瑞林制剂作用持久，但本例中的全身反应似乎是自限性的。应根据治疗需求与再次激发的潜在风险，考虑停药或改用GnRHa类似物的其他制剂。
