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Histrelin Subdermal Implant in Central Precocious Puberty« Back to Volume 23, Issue 3, November 2007 - Table of Contents This important article describes efficacy and safety data related to the use of a single annual subcutaneous implantation of a gonadotropin-releasing analogue (GnRHa) to induce pituitary gonadotropin suppression in children with central precocious puberty. Histrelin provides a continuous slow release at an average rate of 65 µg/d of GnRHa. Its use as a single yearly implant has previously been shown to effectively suppress LH, FSH and testosterone secretion in adult males with prostate cancer.1,2 This report is the first in children with precocious puberty. The procedure of implantation will require more detailed examination with wider clinical use. A pediatric surgeon is required to perform this procedure and in this study, local or general anesthetic or sedation was used. There is no comment about any practical difficulties with the implantation in terms of interference with daily activities such as sports and recreation, or whether the implant became dislodged in some patients. Eugster EA, Clarke W, Kletter GB, et al. Efficacy and safety of histrelin subdermal implant in children with central precocious puberty: A multicenter trial. J Clin Endocrinol Metab. 2007;92:1697-704. Editor’s CommentThe data on sex steroid, LH and FSH evaluation are impressive and clearly show that effective suppression of gonadotrope function occurs for 12 months after a single subcutaneous implantation. The choice of patients may need to be individualized and an implantation technique which avoids general anesthetic would clearly be preferable. Longer term studies to assess recovery of the pituitary-gonadal axis following discontinuation of treatment are important. This first report in children is encouraging and may eliminate the discomfort of monthly or three-monthly injections as currently practiced. Martin O. Savage, MD References - (linked to
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Volume 24 Number 1
May 2008
www.GGHjournal.com
ISSN 1932-9032
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