Tuesday, May 11, 2021

Development of central precocious puberty following cannabinoid use for pediatric epilepsy

Krishnan A, Agwu JC, Kallappa C, et al. Development of central precocious puberty following cannabinoid use for paediatric epilepsy: causal or coincidence? BMJ Case Reports CP 2021;14:e239678.


Research suggests a role for cannabidiol oil in managing certain forms of paediatric onset epilepsy. However, studies on the impact of cannabis on the hypothalamo-pituitary-gonadal (HPG) axis have conflicting results. Delta-9-tetrahydrocannabinol (Δ9-THC) acutely inhibits gonadotropin-releasing hormone in the hypothalamus, reducing testosterone levels by 65% in rhesus monkeys. Additionally, there have been reports of pubertal arrest and delayed puberty in male cannabis users. In contrast, other studies have reported higher testosterone levels following long-term cannabis use. 

A 2-year-old boy presented with testicular enlargement, increased penile length and growth of coarse pubic hair developing over 6 months. His mother procured cannabidiol oil online, which he started taking 7 months earlier for severe epilepsy refractory to medical management. Subsequent investigations confirmed central precocious puberty. While it is unclear whether the precocious puberty is a direct consequence of HPG axis activation by Δ9-THC, this case demonstrates a temporal association between cannabis use and development of precocious puberty.

Courtesy of: https://www.medscape.com/viewarticle/950725?src=WNL_mdpls_210511_mscpedit_neur&uac=60196BR&spon=26&impID=3368378&faf=1

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