Transient synovitis associated with leuprolide depot (Lupron).

Area of Science:

• Pediatric Endocrinology
• Pharmacology
• Rheumatology

Background:

• Central precocious puberty (CPP) requires timely intervention to prevent adverse outcomes.
• Gonadotropin-releasing hormone agonists (GnRHa) are a standard treatment for CPP, with generally favorable safety profiles.
• Rare local and systemic hypersensitivity reactions have been reported with GnRHa use.

Purpose of the Study:

• To report a case of severe hip pain and joint effusion following depot leuprolide acetate injection for CPP.
• To discuss the management of suspected hypersensitivity reaction to GnRHa therapy.
• To highlight the option of switching to an alternative GnRHa analog for continued treatment.

Main Methods:

• A 6.6-year-old female with confirmed CPP received a 3-month depot leuprolide acetate injection.
• Clinical presentation, diagnostic workup (including hip ultrasound), and treatment course were documented.
• Allergy consultation informed the decision to switch to an alternative GnRHa analog (Triptodur).

Main Results:

• Six hours post-injection, the patient developed severe right hip pain, refusal to ambulate, and low-grade fever.
• Hip ultrasound revealed joint fluid accumulation, consistent with an inflammatory reaction.
• Symptoms gradually resolved over two weeks; subsequent treatment with Triptodur was well-tolerated.

Conclusions:

• While GnRHa therapy is effective for CPP, rare adverse events like severe joint reactions can occur.
• Prompt recognition and management, including potential discontinuation or switching of the agent, are crucial.
• Alternative GnRHa formulations may offer a viable option for patients experiencing hypersensitivity reactions.