ESPE2021 ePoster Category 2 Pituitary, neuroendocrinology and puberty (48 abstracts)
Sterile Abscess Formation with Two Different GnRH Analogues: Three Case Reports
Gulin Karacan Kucukali 1 , Şervan Ozalkak 1 , Havva Nur Peltek Kendirci 2 , İlknur Bostancı 3 , Senay Savas Erdeve 1 & Semra Cetinkaya 1
1Health Sciences University, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Pediatric Endocrinology Clinic, Ankara, Turkey; 2Hitit University, Erol Ucok Training and Research Hospital, Pediatric Endocrinology Clinic, Çorum, Turkey; 3Health Sciences University, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Pediatric Allergy and Clinical Immunology Clinic, Ankara, Turkey
Introduction: Gonadotropin releasing hormone analogs(GnRHa) have been used safely for many years in the treatment of central precocious puberty(CPP).Although rare; pain, swelling, erythema at the injection site are known local side effects in patients receiving GnRHa treatment and are temporary.Sterile abscess(SA) development is also one of the rare local side effects.We presented three cases of treatment failure due to the development of SA after GnRHa therapy.
Case Presentations: The patients who were followed up with CPP between 2018-2020 in our clinics were evaluated.We found the three sterile abscess(1.07%) of the 278 patients [receiving triptorelin acetate(TA) or leuprolide acetate(LA)].The laboratory and clinical characteristics of the cases are summarized in Table-1.In the first case, SA recurred despite the treatment was switched to the another preparation.We had to stop treatment in all cases.
| Cases | 1 | 2 | 3 |
| Age(years) | 65/12 | 72/12 | 87/12 |
| Complaint | Pubic hair | Breast development | Breast development |
| Weight SDS | 2.38 | 1.62 | 1.8 |
| Height SDS | 2.66 | 0.38 | 1.23 |
| BMI SDS | 1.48 | 1.73 | 1.58 |
| Breast&Pubic hair stage(Tanner) | III&III Cliteromegaly | III&I | III&III |
| Bone Age(years) | 11 | 810/12 | 11 |
| Mother’/Father’ height(cm) | Not available (adopted) | 149/170.6 | 160/171 |
| Basal LH&FSH (mIU/L) | 0.1&2 | <0.07&2.41 | 9.41&7.79 |
| E2(pg/ml) | <12.1 | 12.9 | 45.7 |
| Peak LH&FSH after LHRH stimulation | 24.2&17.57 | 9.27&14.6 | - |
| Standard dose ACTH stimulation | Peak cortisol 10 mg/dl, peak 17OHP42.2 ng/ml | ||
| Pelvic Ultrasound | Pubertal | Pubertal | Pubertal |
| Tryptase(mg/l) (N:<11.4 ng/ml) | - | 38.6 | 3.98 |
| Diagnosis | CAH+CPP | CPP | CPP |
| Treatment | Hydrocortizone+LA | LA | LA |
| Which drug causes steril abcess | LA and TA | LA | LA |
| The last drug doses | 7.5 mg/28 days | 3.75 mg/28 days | 7.5 mg/28 days |
| The timing of steril abcess | 4. dose | 12. dose | 5. dose |
| Injection site change | Scar | Scar | Scar |
Conclusion: Although SA is a rare side effect, it is very important as it causes patients to be left untreated.In our cases, the active substance of the drug accumulates in the localization of SA and cannot be absorbed, so it cannot enter the systemic circulation.Therefore, puberty cannot be suppressed.Also, often leaving a scar is annoying for patients and their families.We suggest that if a dose increase is required, SA may develop.For this, we recommend the injection site check.If SA develops, we recommend discontinuing the treatment and not insisting on treatment.
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