Endocrine Abstracts

JOINT3543

Introduction: Gonadotropin-releasing hormone analog (aGnRH) is used for the treatment of central precocious puberty (CPP) in childhood and has a good safety profile, with minimal side effects like menopause-like symptoms or local changes at the injection side. In the literature, there are a couple of case reports about the development of transient hypertension during aGnRH treatment.

Case report: We present a case of a girl with a fast progression of CPP with transient arterial hypertension developed during therapy with aGnRH. At the age of 8 years and 9 months, she was diagnosed in the Paediatric Endocrinology Department due to breast and pubic hair development before the age of 8 years. After LH-RH domination of LH was found, fast progression of breast development and advancement of bone age was observed, and bone age was 10 years. Her height was 135,8 cm (50-75pc), her weight was 32,5 kg (50-75pc), and her target height was 169 cm (50-75pc). Therapy with Diphereline SR was initiated. At the age of 8 years and 11 months, she started complaining of recurrent headaches and nose bleeding; BP was 135/85 mmHg at the beginning, with the progression to 155/104 mmHg six months later. In the abdomen ultrasound, double right kidney vessels were found. Hormonal profile with renin, aldosterone, and metoksycatecholamin were in the normal range. She was consulted with an ophthalmologist, and an eye fundus examination revealed no abnormalities. Heart image in echocardiography was proper, but LVMI was elevated at 39,46 (> 95pc for sex and age). In ambulatory blood pressure monitoring (ABPM), hypertension was diagnosed, and treatment with amlodipine was recommended; an initial dose was 2,5mg once a day. Although the treatment, BP was still above the normal range in home monitoring, and in ABPM, ACEI was added to the therapy. At the age of 10 years, due to the development of symptomatic hypertension with heart complications and due to mitigation of CPP progression, treatment with aGnRH was finished. After a month in ABPM, blood pressure was much below 50pc, and amlodipine was discontinued. After the following two months, due to BP values much below 50pc, ACEI was also discontinued. BP remains in the normal range.

Conclusions: Despite the good safety profile of aGnRH, hypertension could be a significant problem during therapy. Based on our case and other earlier reports, regular evaluation of BP should be a part of patient with CPP monitoring.