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[How to manage a symptomatic ovarian follicular cyst in a female child?]
C Pienkowski1, M T Tauber, N Beladj
1Service de pédiatrie, unité d'endocrinologie, CHU Purpan, Toulouse, France.
Insights
Follicular ovarian cysts in young girls can be challenging to treat, sometimes requiring surgery. Recurrence with pubertal activity may necessitate long-term gonadotropin-releasing hormone (GnRH) agonist therapy.
Area of Science:
- Pediatric Endocrinology
- Pediatric Surgery
- Gynecology
Background:
- Ovarian cysts are common in childhood, but most are non-functioning.
- Follicular cysts in young children present unique treatment challenges.
Observation:
- Three cases of young girls presenting with acute abdominal symptoms due to ovarian cysts are described.
- Presentations included ovarian torsion, necrosis, and genital hemorrhage with precocious puberty.
- Diagnostic imaging revealed heterogeneous ovarian masses, with calcifications in one case.
Findings:
- Surgical intervention (ovariectomy) was required in all cases due to complications like torsion and necrosis.
- Post-surgical pubertal activity and elevated gonadotropins were observed in some cases.
- Treatment with gonadotropin-releasing hormone (GnRH) agonists was employed to manage recurrent pubertal activity.
Implications:
- These cases highlight the difficulties in managing follicular ovarian cysts in pediatric patients.
- The potential for cyst recurrence and associated pubertal manifestations warrants consideration of long-term GnRH agonist therapy.
- Further discussion is needed regarding the optimal duration of GnRH agonist treatment for these conditions.
Background:
--Ovarian cysts are common in childhood but most are non functioning. Treatment of those follicular cysts that develop in young children may be difficult.
Case Reports:
Case no. 1.--A 1 1/2 month-old baby was admitted because of an acute abdominal syndrome. Ultrasonography showed a pelvic, heterogeneous mass without calcifications. Laparotomy showed right ovarian torsion with necrosis of a cyst requiring ovariectomy. At that time, there was an isolated increase in FSH after LHRH stimulation. A transitory premature thelarche without pubertal type response to LHRH was seen at the age of 3 months. Clinical and ultrasonographic controls remain normal with a follow-up of 1 year. Case no. 2.--A 4 yr 10 m-old girl was admitted because of an acute abdominal syndrome. Ovariectomy was necessary because laparotomy showed right ovarian torsion with necrosis of a cyst. Recurrent abdominal pain, 4 months later, was associated with an enlarged left ovary without sexual precocity. Gonadotropin were slightly increased after LHRH stimulation and the patient was given LHRH agonist that suppressed endogenous LHRH within 3 months. Clinical and ultrasonographic controls remain normal 1 year after cessation of treatment. Case no. 3.--A 19 month-old girl was admitted because of a genital hemorrhage with recent development of secondary sexual characteristics. Skeletal age was 2 yrs. Ultrasonography showed an enlarged uterus and a left ovarian cyst, heterogenous with calcifications. Plasma levels of estradiol were increased but gonadotropin were normal. Ovariectomy was performed, followed by disappearance of secondary sexual characteristics. However, the patient was given LHRH agonist at the age of 2 yr 7 mo because of recurrent pubertal activity.
Conclusions:
--These cases underline the difficulty in treating follicular cysts in young girls. The possibility of cyst recurrence with manifestations of pubertal activity after ovariectomy lead to discuss indication of LHRH agonists for an undetermined duration.