Pseudotumor cerebri in patient on leuprolide acetate for central precocious puberty
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(2020) 2020:22
CASE REPORT
Open Access
Pseudotumor cerebri in patient on leuprolide acetate for central precocious puberty Anjumanara Anver Omar1*, Godfrey Nyaga2 and Lucy N Wainaina Mungai1
Abstract Background: Gonadotropin releasing hormone agonists (GnRHa) are well established as a standard of care for the treatment of central precocious puberty (CPP) worldwide. While numerous delivery systems and routes of administration exist, depot intramuscular injections or sustained-release preparations have been most widely used. Leuprolide acetate is well tolerated among children though some can develop some complications. Case presentation: We present a case report of a 6.5 year old girl with central precocious puberty who developed signs of pseudotumor cerebri after 2 doses of leuprolide acetate 3.75 mg given monthly. Systemic exam and other tests to look for the cause did not yield anything. However, fundoscopy showed marked papilloedema with blurred disc margins. After six weeks’ treatment with acetazolamide and withdrawal of the GRNHa the papilloedema resolved. Conclusions: If a patient presents with complaints such as headache, nausea, vomiting, and double vision in pediatric patients treated with GnRH analogue one should highly consider the presence of pseudotumor cerebri and fundus examination be performed. Keywords: Gonadotropin releasing hormone agonist, Central precocious puberty, Leuprolide acetate, Pseudotumor cerebri
Background Central precocious puberty (CPP) refers to premature activation of the hypothalamic–pituitary–gonadal (HPG) axis, resulting in early development of secondary sexual characteristics [1]. Gonadotropin releasing hormone agonists (GnRHa) are well established as a standard of care for the treatment of CPP worldwide [1]. While numerous delivery systems and routes of administration exist, depot intramuscular injections or sustained-release Leuprolide acetate depot, Triptorelin pamoatede pot which are each available as monthly and 3-monthly depot preparations are frequently used. Histrelin acetate implant which is approved for 12 months treatment, has been found to be effective for upto 2 years [1, 2]. Previously,
monthly depot GnRHa were most frequently used. However, additional 3-monthly and 6-monthly formulations, as well as subcutaneous implants, have become available over the past ∼10 year [2]. Leuprolide acetate is well tolerated among children though some can develop sterile abscess at the injection site, menopause-like symptoms, headache, emotional disorders, syncope, osteoporosis, vasodilatation, and peripheral edema as adverse effect to the drug [2–4]. Pseudotumor cerebri (PTC) associated with leuprolide acetate as an adverse effect is extremely rare with only few cases reported in literature [3–5]. We present a case report of a girl with central precocious puberty who developed pseudotumor cerebri with visual loss associated with the use of leuprolide acetate a GnRH analogue.
* Correspondence: [email protected] 1 Department of Paediatrics and Child Health-Nairobi, Univers
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