Name of the Procedure:

Common Names: Histrelin Implant, Supprelin LA
Technical Term: Histrelin Acetate Subcutaneous Implant

Summary

The Histrelin implant (Supprelin LA) is a small, flexible tube that is inserted under the skin to release medication over a long period. It is primarily used to treat children with central precocious puberty (early onset of puberty).

Purpose

The Histrelin implant is used to:

• Delay early onset puberty in children with central precocious puberty.
• Regulate hormone levels to prevent premature development.

Indications

The procedure is indicated for children who:

• Are diagnosed with central precocious puberty.
• Show advanced signs of puberty before the age of 8 in girls and 9 in boys.
• Have a rapid advancement in bone age compared to their chronological age.

Preparation

Preparation for the procedure typically includes:

• Consultation with a pediatric endocrinologist.
• Pre-procedure blood tests and bone age X-ray to assess hormone levels and bone development.
• No specific fasting requirements, but fasting may be necessary if sedation is planned.
• Adjustment of any current medications as advised by the healthcare provider.

Procedure Description

1. Pre-procedure:

   • The patient's arm is cleaned with an antiseptic solution.
   • Local anesthesia is applied to numb the area.

2. Insertion:

   • A small incision is made in the upper arm.
   • The histrelin implant is inserted just under the skin using a special applicator.
   • The incision is closed with sutures or adhesive strips and covered with a sterile dressing.

3. Post-procedure:

   • The patient is monitored for a short period before being allowed to go home.

Duration

The procedure typically takes about 15 to 30 minutes.

Setting

The procedure is usually performed in an outpatient clinic or a doctor's office.

Personnel

• Pediatric Endocrinologist or a trained healthcare provider (e.g., physician assistant, nurse practitioner)
• Nurses to assist with the procedure

Risks and Complications

Common risks:

• Pain or discomfort at the insertion site
• Bruising or swelling
• Implant site infection

Rare risks:

• Allergic reaction to the implant
• Incorrect placement requiring repositioning

Benefits

The expected benefits include:

• Delayed onset of puberty, allowing the child to develop at a standard rate.
• Improvement in final adult height.
• Symptom relief typically within a few weeks after implantation.

Recovery

Post-procedure care includes:

• Keeping the incision site clean and dry for a few days.
• Avoiding strenuous activities for about a week.
• Follow-up appointments to monitor hormone levels and implant status.
• The implant is replaced annually to maintain its effectiveness.

Alternatives

Alternative treatment options:

• GnRH agonist injections or nasal sprays.
• Pros: Non-invasive compared to implant placement.
• Cons: Requires frequent dosing, making it less convenient.

Patient Experience

During the procedure:

• The patient may feel a brief sting when the local anesthetic is injected.
• Pressure during the implant placement but no significant pain due to the anesthetic.

After the procedure:

• Mild discomfort or soreness at the incision site.
• Pain management includes over-the-counter pain relievers as needed.
• Comfort measures include keeping the area clean and avoiding activities that could impact the insertion site.