Management of Systemic Hypersensitivity Reactions to Gonadotropin-Releasing Hormone Analogues during Treatment of Central Precocious Puberty

Kirkgöz, Tarık; Karakoç-Aydıner, Elif; Buğrul, Fuat; Abalı, Zehra Yavaş; Helvacioglu, Didem; Kıykım, Ayça; Eltan, Sevgi Bilgiç; Kasap, Nurhan; Barış, Safa; Ozen, Ahmet; Güran, Tülay; Bereket, Abdullah; Turan, Serap

doi:10.1159/000505329

Cited by 8 publications

(8 citation statements)

References 18 publications

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“…Kirkgoz et al ( 22 ) recently reported nine pediatric cases experienced systemic hypersensitivity reactions to GnRHa during the treatment of CPP. One of the cases in this report had similarities to the currently presented case with palpable purpuric rash on her legs, which was assumed to be Henoch-Schönlein purpura by her pediatrician.…”

Section: Discussionmentioning

confidence: 99%

Vasculitis-like Palpable Purpuric Rash Induced by Decapeptyl in a Pediatric Patient Diagnosed Central Precocious Puberty

Galip¹,

Ankay²,

Bundak³

2023

Jcrpe

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Central precocious puberty (CPP) is defined as the appearance of secondary sexual signs in girls younger than eight years of age or the onset of menarche before the age of 10 years. Gonadotropin-releasing hormone analogs (GnRHa) are the most effective therapy in CPP. Drug-induced hypersensitivity vasculitis is an inflammation of blood vessels, which may be due to the use of a number of pharmacologic agents. This case report describes drug-induced vasculitis in a girl being treated with Decapeptyl. A 7.25 year-old girl was admitted to Pediatric Endocrinology outpatients with premature breast development. She was diagnosed with CPP on the basis of physical examination and laboratory findings and tripoteline acetate (Decapeptyl ® ) treatment was initiated. She experienced multiple widespread skin rashes and mild abdominal pain with high temperature eight hours after the second dose of Decapeptyl. She was admitted to hospital with the diagnosis of drug-induced vasculitis and a single dose of intravenous methyl-prednisolone (1 mg/kg) and oral cetirizine was given. Her blood and urine analysis revealed no other organ involvement, other than skin. On the third day, the purpuric lesions began to resolve and had completely disappeared by the sixth day. Her treatment for CPP was switched to Depot Leuprolide acetate and she continued her treatment for two years uneventfully. To the best of our knowledge, this is the first report of a child with CPP experiencing drug-induced vasculitis due to tripotelin injection. Effective treatment may be continued by switching to an alternative gonadotropin releasing hormone analog.

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Section: Discussionmentioning

confidence: 99%

Vasculitis-like Palpable Purpuric Rash Induced by Decapeptyl in a Pediatric Patient Diagnosed Central Precocious Puberty

Galip¹,

Ankay²,

Bundak³

2023

Jcrpe

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“…Puberty is a transition period from childhood to adulthood with a gradual maturation of the sexual and reproductive systems. Children with central precocious puberty (CPP) show an advanced initiation of hypothalamus-pituitary-gonadal (HPG) axis function, which leads to a rapid development of internal and external reproductive organs and secondary sexual sign before the age of 8 in girls and the age of 9 in boys (Leger, 2002;Kirkgoz et al, 2020). The incidence of CPP is about 1/5,000-10,000, accounting for more than 30% of the total number of pediatric endocrine outpatients (Abreu et al, 2015;Li C. Y. et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

A Novel Loss-of-Function MKRN3 Variant in a Chinese Patient With Familial Precocious Puberty: A Case Report and Functional Study

et al. 2021

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Background: Central precocious puberty (CPP) is one of the most common and complex problems in clinical pediatric endocrinology practice. Mutation of the MKRN3 gene can cause familial CPP.Methods and Results: Here we reported a Chinese patient bearing a novel MKRN3 mutation (c.G277A/p.Gly93Ser) and showing the CPP phenotype. Functional studies found that this mutation of MKRN3 attenuated its autoubiquitination, degradation, and inhibition on the transcriptional activity of GNRH1, KISS1, and TAC3 promoters.Conclusion: MKRN3 (Gly93Ser) is a loss-of-function mutation, which attenuates the inhibition on GnRH1-related signaling, suggesting that this mutant can lead to central precocious puberty.

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“…There are differences in additives or stabilizing agents in GnRHa that may be causing hypersensitivity reactions. [ 8 ] In the patient who had reactions to both GnRHa, reactions to additives should be investigated.…”

Section: Discussionmentioning

confidence: 99%

“…Due to cases that were shown cross-reactivity between two different GnRHa, before switching the medication to the other analogs, skin tests with alternative medications should be done. [ 8 9 ] Since depot forms of GnRH analogs contain more content than the active drug, it should be kept in mind that such commercial preparations may be exceeding the concentration of irritants on the skin for IDT and SPT. This problem causes difficulty in evaluating tests and a lack of data in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…Despite being well-tolerated by most of the patients, hypersensitivity reactions in a small proportion of cases receiving LA and TA have been reported in the literature. [ 4 8 ] Local reactions with induration and aseptic abscess at the injection site are well known. [ 9 ] In addition to local reactions, cases of anaphylaxis have been reported in a small number of patients.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Hypersensitivity Reactions with Leuprolide Acetate and Triptorelin Acetate in Children

Misirlioglu¹,

Metbulut²,

Adıgüzel³

et al. 2021

Indian Journal of Endocrinology and Metabolism

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Introduction: Gonadotropin releasing hormone analogues (GnRHa) are commonly used to treat central precocious puberty (CPP). Generally, they are well-tolerated; however adverse reactions have been reported. Local adverse events occur in 10-15% of the patients who were treated with GnRHa. Anaphylactoid reactions with GnRHa are very rarely seen. The aim of this study is to report our clinical experience with hypersensitivity reactions seen in pediatric patients receiving leuprolide acetate (LA) and triptorelin acetate (TA) in CPP at the single pediatric tertiary medical center and to evaluate the incidence rate of hypersensitivity reactions. Methods: This retrospective study included children with CPP who were treated with GnRHa (LA and TA) at our hospital between January 2013 and December 2020. We analyzed clinical characteristics of patients who experienced adverse reactions and analyzed the incidence rate. Results: Seven side effects (adverse reactions) (0.69%) were observed among total of 1010 CPP patients who were treated with TA and LA. Sterile abscesses were observed in 3 patients (0.29%). None of the patients had an anaphylaxis. Tremors of both hands, a vomiting episode, an urticarial rash, and musculoskeletal stiffness were observed in one patient each. Conclusion: In our study, mild reactions were seen in 7 patients. GnRHa can be safely used and well-tolerated medications; but exceedingly rare, severe reactions can be developed.

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Management of Systemic Hypersensitivity Reactions to Gonadotropin-Releasing Hormone Analogues during Treatment of Central Precocious Puberty

Cited by 8 publications

References 18 publications

Vasculitis-like Palpable Purpuric Rash Induced by Decapeptyl in a Pediatric Patient Diagnosed Central Precocious Puberty

Vasculitis-like Palpable Purpuric Rash Induced by Decapeptyl in a Pediatric Patient Diagnosed Central Precocious Puberty

A Novel Loss-of-Function MKRN3 Variant in a Chinese Patient With Familial Precocious Puberty: A Case Report and Functional Study

Evaluation of Hypersensitivity Reactions with Leuprolide Acetate and Triptorelin Acetate in Children

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