Case Report: A diagnostic challenge: rare adverse effects of GnRH analogue therapy in a late pubertal pediatric patient
-
By
-
Dao-Chen Lin
-
Pei-Shan Tsai
-
Tao-Yeuan Wang
-
Wen-Ko Su
-
July 17, 2026
Clinical Scorecard: Case Study: Diagnostic Difficulties Associated with Uncommon Adverse Reactions to GnRH Analogue Treatment in a Late Pubertal Child
At a Glance
| Category | Detail |
|---|
| Condition | Adnexal Torsion |
| Key Mechanisms | Complete or partial twisting of the vascular pedicle within the suspensory ligament leading to lymphatic obstruction and arterial occlusion. |
| Target Population | Pediatric and adolescent females, particularly those aged 9-14 years. |
| Care Setting | Pediatric emergency and surgical care. |
Key Highlights
- Adnexal torsion accounts for approximately 15% of all torsion cases in pediatric populations.
- The condition is a critical surgical emergency and ranks as the fifth most common gynecologic emergency in patients under 20 years of age.
- GnRH analogue therapy can lead to rapid ovarian hyperstimulation and torsion in post-menarchal females.
- Prompt diagnosis and surgical intervention are vital to prevent long-term consequences for fertility.
Guideline-Based Recommendations
Diagnosis
- Utilize pelvic ultrasonography and CT imaging to assess for ovarian enlargement and torsion.
Management
- Urgent surgical exploration is required for suspected adnexal torsion.
Monitoring & Follow-up
- Post-operative monitoring of serum estradiol levels is recommended.
Risks
- Risk of ovarian necrosis and long-term fertility issues if not treated promptly.
Patient & Prescribing Data
Late pubertal females receiving GnRH analogue therapy.
Careful monitoring for signs of ovarian hyperstimulation and torsion is essential.
Clinical Best Practices
- Maintain clinician vigilance regarding severe ovarian complications in older pediatric cohorts.
- Educate families about potential risks associated with GnRH analogue therapy.
Related Resources & Content
