Effect of GnRH Analogs Leuprolide-Acetate and Triptorelin on Bone Mineral Density in Girls with Central Precocious Puberty

바우어 지그프리드,남효경,이영준,박상희,이기형 대한소아내분비학회 2011 Annals of Pediatirc Endocrinology & Metabolism Vol.16 No.2

Purpose:The objective of this study was to evaluate the effect of gonadotropin releasing hormone analog (GnRHa) treatment on bone mineral density (BMD) in girls with central precocious puberty (CPP). Further we investigated the differences in the effect on BMD by using the GnRHa leuprolide-acetate and triptorelin. Methods: Sixty-one females with CPP were enrolled in the study, the lumbar spine BMD was measured by dual energy x-ray absorptiometry before treatment, after one year (n=61) and after two years (n=24) of treatment. Lumbar spine BMD standard deviation scores (SDS) were compared according to chronological age (CA) and bone age (BA) for the whole group, as well as for the group A, treated with leuprolide-acetate (n=40), and the group B, treated with triptorelin (n=21). Results: All subjects showed significant increment in BMD during treatment (P ˂0.05). Lumbar spine BMD SDS for CA and BA showed no significant changes before and during treatment. Group A and group B, within each group, showed no significant changes in lumbar spine BMD SDS for CA and BA during treatment. Conclusion: Our study suggests that lumbar spine BMD was not impaired in girls treated with GnRHa for CPP and both leuprolide-acetate and triptorelin showed comparable effects on lumbar spine BMD during treatment.(J Korean Soc Pediatr Endocrinol 2011;16:106-111)

Effectiveness of the triptorelin stimulation test compared with the classic gonadotropin-releasing hormone stimulation test in diagnosing central precocious puberty in girls

Kim Yu Jin,Hwangbo Jung,Park Kyu Hyun,Kang Eungu,Nam Hyo-Kyoung,Rhie Young-Jun,Lee Kee-Hyoung 대한소아내분비학회 2024 Annals of Pediatirc Endocrinology & Metabolism Vol.29 No.2

Purpose: The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard for diagnosing central precocious puberty (CPP). Gonadorelin (Relefact) is used for the test but is not always readily available; triptorelin is used as an alternative. The purpose of this study was to evaluate the diagnostic validity of the triptorelin test compared with the GnRH test in the diagnosis of CPP in girls.Methods: This retrospective study included 100 girls with premature thelarche (PT) who underwent a hypothalamic-pituitary-gonadal axis evaluation. In the overall group, 50 girls were tested with intravenous gonadorelin (Relefact) and 50 girls were tested with subcutaneous triptorelin acetate (Decapeptyl). Luteinizing hormone (LH) and follicle-stimulating hormone levels were measured at baseline and 30, 45, 60, and 90 minutes after gonadorelin injection or 30, 60, 90, and 120 minutes after triptorelin injection.Results: Clinical characteristics of age, height, weight, body mass index, and bone age were similar between the 2 groups. The highest LH level was reached 60 minutes after stimulation in both groups. Approximately 20% of the gonadorelin group and 24% of the triptorelin group were diagnosed with CPP (<i>P</i>=0.52). Among those diagnosed with CPP, the mean peak LH concentrations were 8.15 mIU/mL and 9.73 mIU/mL in the gonadorelin and triptorelin groups, respectively.Conclusion: The triptorelin test showed similar trends of LH elevation and diagnostic rate compared with the traditional GnRH test for diagnosing CPP. This suggests that the triptorelin test may be a valid alternative to the GnRH test for differentiating CPP from self-limiting PT. Our study also demonstrated that a triptorelin stimulation test for up to 120 minutes was sufficient to diagnose CPP.

Efficacy of Triptorelin 3-Month Depot Compared to 1-Month Depot for the Treatment of Korean Girls with Central Precocious Puberty in Single Tertiary Center

Chung Lindsey Yoojin,Kang Eungu,Nam Hyo-Kyoung,Rhie Young-Jun,Lee Kee-Hyoung 대한의학회 2021 Journal of Korean medical science Vol.36 No.34

Background: Triptorelin depot is largely used to treat central precocious puberty (CPP) in children, and a 3-month depot has been introduced. However, data about the 3-month gonadotropin-releasing hormone use for treatment of CPP in Korean girls are not available. This study was conducted to compare the efficacy of a triptorelin 11.25 mg 3-month depot with that of a 3.75 mg 1-month depot in suppressing pubertal development for the treatment of CPP. Methods: A retrospective study, including 106 girls with CPP treated with triptorelin, was conducted. Fifty patients were treated with a triptorelin 3-month depot, and 56 were treated with a triptorelin 1-month depot. Serum luteinizing hormone (LH), follicle-stimulating hormone, and estradiol levels were analysed every 6 months after the visit. The height and bone age of each patient was evaluated at the beginning of treatment, after 6 months, and one year after therapy. Results: The baseline characteristics of the girls treated with a 3-month depot were similar to those of the girls treated with a 1-month depot. A suppressed levels of LH to the triptorelin injection (serum LH < 2.5 IU/L) at 6 months was seen in 90.0% and 98.2% of the girls treated with the 3-month and 1-month depots, respectively (P = 0.160). After 1 year of treatment, a suppressed levels of LH was seen in 93.5% and 100% of the girls treated with the 3-month and 1-month depots, respectively (P = 0.226). Height velocity showed no significant difference between the two groups. Degree of bone age advancement decreased from 1.22 ± 0.07 and 1.22 ± 0.08 years at baseline (P = 0.914) to 1.16 ± 0.07 and 1.17 ± 0.08 in the girls treated with the 3-month and 1-month depots after 1 year, respectively (P = 0.481). Conclusion: This study showed that the efficacy of long-acting triptorelin 3-month was comparable to 1-month depot regarding hormonal suppression and inhibition of bone maturation. The triptorelin 11.25 mg 3-month depot is an effective treatment for girls with CPP.

Triptorelin Acetate-Loaded Poly(lactide-co-glycolide) (PLGA) Microspheres for Controlled Drug Delivery

박경희,육순홍,정구영,김명기,박목순,신용국,황재관 한국고분자학회 2012 Macromolecular Research Vol.20 No.8

Triptorelin acetate-loaded poly(lactide-co-glycolide) (PLGA) microspheres have been prepared in binary solvent mixtures composed of dichloromethane (DCM) and acetone (AC). The surface morphology of PLGA microspheres was examined by scanning electron microscopy with varying solvent composition, and the size distribution of PLGA microspheres was measured using a particle size analyzer. Triptorelin acetate is a luteinizing hormonereleasing hormone analog that is used as a model peptide drug. With the increase of AC content in the binary solvent mixture, PLGA microspheres with smooth surface were obtained and this led to an increased loading efficiency with the decreased particle size. For the application of PLGA microspheres as a controlled drug delivery system, the release pattern of triptorelin acetate was observed and the stability of triptorelin acetate-loaded PLGA microspheres was observed with or without mannitol. The sustained release pattern was observed after the initial burst effect and the improved stability of PLGA microspheres was observed with mannitol.

체외수정시술을 위한 과배란유도시 Nafarelin 과 Triptorelin 사용에 따른 임상성적의 비교

목정은,김낙연,김정훈,강병문,장윤석 울산대학교 의과대학 1996 울산의대학술지 Vol.5 No.1

Gonadotropin-releasing hormone agonists(GnRH-a) vary in structure and route of administration. We performed this study to compare patient response to intranasal nafarelin acetate versus subcutaneous triptorelin as adjuncts to ovulation induction for in vitro fertilization(IVF). From October 1995 to May 1996, sixty-four patients with tubal factor infertility entering their 79 cycles of IVF were randomized to receive either intranasal nafarelin acetate(Group Ⅰ, 38 cycles) or subcutaneous triptorelin(Group Ⅱ, 41 cycles). Controlled ovarian hyperstimulation(COH) using luteal long protocol of GnRH-a was used in all patients. Patient characteristics in the two groups did not differ significantly, nor did sperm parameters or endocrine profiles. There was no significant difference in ovarian response as indicated by duration of GnRH-a administration before ovarian stimulation, number of ampules of gonadotropin used and duration of gonadotropin administration in ovarian stimulation, and serum E( ) level and number of follicles(≥14mm) on the day of hCG administration between the two groups. There were no significant differences in clinical results of oocyte and embryo obtained such as number of oocytes retrieved, oocytes fertilized, embryos cleaved, embryos frozen, and embryos transfered between the two groups. There were also no significant differences between group Ⅰ and group Ⅱ in clinical pregnancy rate(31.6% versus 34.1%) and abortion rate per clinical pregnancy(8.3% versus 14.3%). This study suggests that intranasal nafarelin acetate as well as subcutaneous triptorelin can be used successfully in ovulation induction using luteal long protocol of GnRH-a.

트립토렐린 아세테이트 1차 투여에 과민반응을 보인 8세 여아

정나영 ( Nayoung Jung ),이지은 ( Ji Eun Lee ),임대현 ( Dae Hyun Lim ),김정희 ( Jeong Hee Kim ) 대한천식알레르기학회 2021 Allergy Asthma & Respiratory Disease Vol.9 No.4

Triptorelin is a synthetic gonadotropin-releasing hormone agonist for the treatment of precocious puberty in children. Among the triptorelin side effects, drug hypersensitivity reactions, including anaphylaxis, can rarely occur, mostly after repeated exposure to the drug. We present a first case of an 8-year-old girl with central precocious puberty who developed anaphylaxis to the first injection of decapeptyl depot, which contains triptorelin acetate (D,L lactide coglycolide), dextran 70, and polysorbate 80. She showed 2 posi-tive reactions in an intradermal test to decapeptyl depot, suggesting that it is an IgE-mediated reaction to one of its components. Considering this was the first exposure to tryptorelin, it might be a reaction to polysorbate. As there are many therapeutic products containing polysorbate which can cross-react with polyethylene glycols, physicians should pay attention to immediate reactions to drugs containing polysorbate. (Allergy Asthma Respir Dis 2021;9:255-258)

진성성조숙증 환아에서 다른 두 종류의 생식샘자극호르몬방출호르몬 작용제 치료에 의해 발생한 무균 농양

김종문,신영림 대한소아내분비학회 2012 Annals of Pediatirc Endocrinology & Metabolism Vol.17 No.3

Long-acting formulations of gonadotropin-releasing hormone (GnRH) agonists are indicated for treating central precocious puberty. Leuprolide acetate and triptorelin acetate are widely used in Korea. Local reactions related to GnRH agonists, including erythematous macules, granulomas, subcutaneous nodules, and sterile abscesses, are where the most side effects and sterile abscesses occur in less than 2-3% of treated patients. We report on two patients who had been injected with leuprolide acetate for the treatment of central precocious puberty and who subsequently presented with a sterile abscess at the injection sites. After the patients were switched to triptorelin acetate, one patient had another subcutaneous abscess at the injection site, and the other patient had no further problems. There are many theories as to the cause of these local reactions, but the mechanism has still not been elucidated. Further studies are required to identify the mechanism and the relationship between treatment effect and local reaction. 진성 성조숙증의 치료는 생식샘자극호르몬방출호르몬 작용제가 사용되어 지고 있으며 국내에서는 leuprolide acetate 와 triptorelin acetate가 널리 사용되고 있다. GnRHa의 Depot 제제의 경우 주사부위의 홍반성 발진, 육아종, 피하 결절 및 무균 농양 등의 국소 부작용이 발생할 수 있으며 2-3%에서 무균 농양이 발생한다고 알려져 있다. 저자들은 진성 성조숙증으로 진단된 환아 두 명에서 leuprolide acetate로 치료를 시작하였으나 주사 부위의 무균 농양소견이 보여서 triptorelin acetate로 치료를 변경하였고 한명에서는 다시 무균 농양이 발생하였으나 한명에서는 이상반응 없이 치료를 진행한 경우를 경험하였다. 이런 국소 반응의 발생 원인에 대한 여러 이론들이 있으나 현재까지 아직 명확히 밝혀지지 않았으며 치료 효과와의 연관성에 대해서도 더 많은 연구가 필요할 것으로 생각된다.

Significant adverse reactions to long-acting gonadotropin-releasing hormone agonists for the treatment of central precocious puberty and early onset puberty

이지우,김형진,최윤미,강희숙,김순기,전용훈,이지은 대한소아내분비학회 2014 Annals of Pediatirc Endocrinology & Metabolism Vol.19 No.3

Purpose: Long-acting gonadotropin-releasing hormone agonists (GnRHa) are commonly used to treat central precocious puberty (CPP) in Korea. Although rare, there have been reports on the characteristic of adverse reactions of GnRHa in CPP among the Korean population. This study was intended to report on our clinical experience regarding significant adverse reactions to long-acting GnRHa in CPP and early onset puberty and to evaluate the prevalence rate of serious side effects. Methods: This retrospective study included children with CPP and early onset puberty, who were administered monthly with long-acting GnRHa (leuprolide acetate, triptorelin acetate) at the outpatient clinic of Department of Pediatrics, at Inha University Hospital, between January 2011 and December 2013. We analyzed the clinical characteristics of patients who experienced significant adverse reactions and evaluated the prevalence rate. Results: Six serious side effects (0.9%) were observed among total of 621 CPP and early onset puberty children with GnRHa therapy. The number of sterile abscess formation was four in three patients (4 events of 621). Anaphylaxis occurred in only one patient, and unilateral slipped capital femoral epiphysis (SCFE) in another one patient. Anaphylaxis occurred after the 6th administration of the monthly depot triptorelin acetate. Unilateral SCFE developed in GnRHa therapy. Conclusion: Sterile abscess formation occurred in 0.6% of CPP and early onset puberty patients from the administration of a monthly depot GnRHa therapy. The occurrences of anaphylaxis and SCFE are extremely rare, but can have serious implications on patients. Clinicians should be aware of these potential adverse effects related to GnRHa therapy in CPP.