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SINGLE HISTRELIN IMPLANT SUPPRESSES PUBERTY FOR FOUR YEARS

Mitchell, Preston, BS

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Tapiador, Carmen, MD

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Endocrine Practice

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; Jacksonville Vol. 22,  (May 2016): 185.

Abstract #845

Objective: To report a case of a patient with persistent hypothalamic-pituitary-gonadal axis suppression after 4 years of Histrelin implant.

Case Presentation: Patient had initial endocrine evaluation at the age of 9 years. She presented with minimal vaginal bleeding. Breast development was at Tanner stage III. Tests disclosed pubertal LH 0.37, FSH 5.01 and estradiol 21 pg/ml. Bone age was 13 years. She received the Histrelin implant. Patient missed several appointments due to maternal mental health issues. Patient returned for implant removal after 4 years. Breast development was still at stage III. Patient had no menstrual bleeding while on the implant. Tests showed suppression of HPG axis (LH 0.12, FSH 1.3 and estradiol 6.4). Bone age was at 15 years. There was difficulty in removing the implant. The implant had severely deteriorated and had amalgamated with the surrounding tissue.

Discussion: Histrelin implant is only FDA approved for 12-month use, containing 50 mg of Histrelin acetate and delivers approximately 65 mcg Histrelin acetate per day (approximately 24 mg/year). Hypothalamic-pituitarygonadal axis suppression with the implant left for 2 years had been previously described. This case demonstrates that the implant can suppress the hypothalamic-pituitarygonadal axis beyond 2 years.

Conclusion: This case and other studies involving the use of a single Histrelin implant beyond 12 months may be cost-effective for treatment of precocious puberty. However, scarring may make it difficult to remove the implant when left beyond 12 months.