INTRODUCTION: Histrelin acetate implant (HI) is an approved treatment option for children with Central Precocious Puberty. Implant duration has been reported to surpass the recommended replacement interval of 1-2 years. Implant breakage is a known potential adverse effect during the extraction procedure. However, the bioactivity of the retained fragment has not been reported previously.
CASE PRESENTATION: We present 3 cases of females with Central Precocious Puberty, who received HI for pubertal suppression and experienced implant breakage during extraction. In 2 cases, the retained fragment suppressed pubertal hormone for 5 years. In the third case, the HI was left in place due to loss of follow-up, and the patient was amenorrheic for the next 6 years. In all 3 cases, menstruation occurred after the HI fragments were surgically removed.
CONCLUSION: Our case series demonstrates that retained HI fragment can be bioactive for up to 5 years. If HI breakage occurs during removal, ultrasound localization and surgical extraction of the fragment should be performed.
