Klin Padiatr 2011; 223 - P086
DOI: 10.1055/s-0031-1273887

Arterial hypertension as a complication of prolonged therapy with GnRH-analogues in adolescent girls

A de Jong 1, A Bökenkamp 1, D Klink 1
  • 1VU University Medical Center, Amsterdam, Niederlande

VU University medical center has a gender clinic specialized in the treatment of transsexual adolescents. The treatment protocol includes a phase of prolonged diagnostics in which puberty is postponed using the GnRH-analogue Triptorelinacetate (Decapeptyl-CR®). Here, we report two patients who developed arterial hypertension during treatment with Decapeptyl.

Case 1 is a biological girl aged 18 years who developed hypertension after starting therapy. Pre-treatment office blood pressure was 117/71 mmHg, weight 54.5kg, height 155 cm. Ambulatory blood pressure monitoring (ABPM) 3 months later showed hypertensive readings of 144/91 mmHg (day) and 124/71 mmHg (night) which normalized after discontinuation of the drug (124/81– day; 99/58– night). Funduscopy was unremarkable.

Case 2, a biological girl, too, was diagnosed with hypertension 15 months after start of treatment with GnRH-analogue. Pre-treatment office blood pressure at the age of 11 8/12 years was 116/62 mmHg, weight 31kg, height 142 cm. At the age of 13 years, mean ABPM were 125/74 mmHg (day) and 117/61 mmHg (night). Funduscopy revealed papilledema and increased intracranial pressure was demonstrated by lumbar puncture (29 cmH2O), which prompted discontinuation of Decapeptyl and a short course of Acetazolamide. 4 months later, ABPM had normalized to106/75 mmHg (day) and 101/51 mmHg (night). Because of progression of puberty it was decided to restart Decapeptyl. A follow-up ABPM revealed recurrence of hypertension (129/74 mmHg day; night not available), which is treated with Nifedipine. Funduscopy has remained normal.

Post-menopausal hypertension has been studied in rat models using surgical ovarectomy or GnRH-analogues. In these models, ovarectomy is associated with alterations is venous and arterial vascular tone, which is reversed by estrogen supplementation. One might speculate that hypogonadism from prolonged Decapeptyl treatment in adolescent females induces comparable changes which are reversible after discontinuation of the drug.

GnRH-analogue - arterial hypertension - complication - puberty