Anshita Aggarwal1, Bindu Kulshreshtha2. 1. Department of Endocrinology, Dr Ram Manohar Lohia Hospital, New-Delhi 110001. Electronic address: anshilh10@gmail.com. 2. Department of Endocrinology, Dr Ram Manohar Lohia Hospital, New-Delhi 110001.
Abstract
BACKGROUND: Catamenial precipitation of attacks of acute intermittent porphyria (AIP) is commonly treated with Gonadotropin-releasing hormone analogs (GnRHas). However, this leads to various adverse effects that may necessitate 'add-back' therapy with estrogen. The literature on the efficacy and safety of such therapy is scarce. CASE: A 15-year-old lady presented to us with recurrent catamenial attacks of AIP. GnRHa therapy leads to near-complete amelioration of the episodes but her bone density worsened as an adverse effect. To circumvent this, low-dose estrogen was added to her regimen as an 'add-back' therapy, which was later coupled with cyclical progesterone. She continues to do well on this regimen, with no new episodes. SUMMARY AND CONCLUSION: GnRHa therapy with estrogen 'add-back' is an attractive option for treating catamenial AIP episodes.
BACKGROUND: Catamenial precipitation of attacks of acute intermittent porphyria (AIP) is commonly treated with Gonadotropin-releasing hormone analogs (GnRHas). However, this leads to various adverse effects that may necessitate 'add-back' therapy with estrogen. The literature on the efficacy and safety of such therapy is scarce. CASE: A 15-year-old lady presented to us with recurrent catamenial attacks of AIP. GnRHa therapy leads to near-complete amelioration of the episodes but her bone density worsened as an adverse effect. To circumvent this, low-dose estrogen was added to her regimen as an 'add-back' therapy, which was later coupled with cyclical progesterone. She continues to do well on this regimen, with no new episodes. SUMMARY AND CONCLUSION: GnRHa therapy with estrogen 'add-back' is an attractive option for treating catamenial AIP episodes.