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Optimizing pediatric histrelin implantation to improve success rates in clinic without sedation

  • Vikram Krishna , Steven L. Lee and Daniel A. DeUgarte EMAIL logo
Published/Copyright: August 18, 2021
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 34 Issue 11

Abstract

Objectives

The purpose of this study was to review our success rate performing the histrelin implant procedure in clinic without sedation.

Methods

A retrospective study was performed for histrelin implant procedures done at our institution from 2008 to 2020. Wilcoxon rank-sum test or Fisher’s exact test was utilized to identify significant differences (p<0.05).

Results

A total of 73 patients underwent 184 histrelin implant procedures from 2008 to 2020. In the past few years, there has been a decrease in procedures for precocious puberty and an increase for gender dysphoria. The majority of procedures were performed in clinic without sedation (82%). The only risk factor associated with requiring sedation was younger age (median 9 vs. 10 years; p<0.003). Complications (i.e. implant fracture or need for counter-incision) were noted in 10 of the procedures (5%). The only risk factor identified for a procedural complication during implant removal/replacement was interval time from insertion (21 vs. 13 months; p<0.01). The only documented wound problem reported was dermatitis in 1 patient (no suture granuloma, dehiscence, or implant extravasation).

Conclusions

Procedural refinements and distraction therapy have enabled us to perform the majority of procedures in clinic without sedation. In our experience, procedural difficulty and complications appear to increase with prolonged implant duration. Histrelin implantation is increasingly being performed for gender dysphoria.

Keywords: gender dysphoria; precocious puberty; subcutaneous implant; supprelin
Corresponding author: Daniel A. DeUgarte, MD, MS, Department of Surgery, UCLA and Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Box 709818 10833 Le Conte Avenue, Los Angeles, CA 90095-7098, USA, Phone: +310 206 2429, Fax: +310 206 1120, Mobile: +310 622 5245, E-mail:

  1. Research funding: None declared.

  2. Author contributions: Study conception and design: VK, DAD, SL. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was waived because of the retrospective study design. Informed consent was obtained for publishing photographs.

  5. Ethical approval: IRB approval was obtained.

  6. Level of evidence: IV.

  7. Type of study: Treatment Study.

  8. Data acquisition: VK, DAD.

  9. Analysis and data interpretation: VK, DAD, SL.

  10. Drafting of the manuscript: VK, DAD.

  11. Critical revision: VK, DAD, SL.

References

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Received: 2021-06-24
Accepted: 2021-08-06
Published Online: 2021-08-18
Published in Print: 2021-11-25

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/jpem-2021-0432
Keywords for this article
gender dysphoria; precocious puberty; subcutaneous implant; supprelin

Articles in the same Issue

  1. Frontmatter
  2. Review Article
  3. An endocrine perspective on menstrual suppression for adolescents: achieving good suppression while optimizing bone health
  4. Original Articles
  5. Anthropometric, metabolic, and reproductive outcomes of patients with central precocious puberty treated with leuprorelin acetate 3-month depot (11.25 mg)
  6. Evaluation of the resilience of the girls with central precocious puberty treated with gonadotropin-releasing hormone analog
  7. The effect of GnRH stimulation on AMH regulation in central precocious puberty and isolated premature thelarche
  8. Association of the apoptotic marker APO1/Fas with children’s predisposing factors for metabolic syndrome and with mean platelet volume
  9. Serum adiponectin, body adiposity and metabolic parameters in obese Egyptian children with Down syndrome
  10. Urinary iodine and thyroglobulin are useful markers in infants suspected of congenital hypothyroidism based on newborn screening
  11. Comparison of plasmapheresis with medical apheresis in terms of efficacy and cost in the acute treatment of hypertriglyceridemia in children with lipoprotein lipase deficiency
  12. Clinical, biochemical and genotypical characteristics in biotinidase deficiency
  13. High uric acid levels in overweight and obese children and their relationship with cardiometabolic risk factors: what is missing in this puzzle?
  14. Optimizing pediatric histrelin implantation to improve success rates in clinic without sedation
  15. Determinants of ultra-processed food consumption in Brazilian children and adolescents with type 1 diabetes mellitus: a cross-sectional study
  16. The prevalence, immune profile, and clinical characteristics of children with celiac disease and type 1 diabetes mellitus in the state of Qatar
  17. Case Reports
  18. A rare and preventable aetiology of neurodevelopmental delay and epilepsy: familial glucocorticoid deficiency
  19. Giant plurihormonal pituitary adenoma in a child – case study
  20. The usefulness of copeptin for the diagnosis of nephrogenic diabetes insipidus in infancy: a case report
  21. A novel synonymous homozygous variant [c.2538G>A (p.Thr846Thr)] in TRPM6 in a patient with hypomagnesemia with secondary hypocalcemia
  22. Idiopathic juvenile osteoporosis in a child: a four-year follow-up with review of literature
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