CBD Oil for Epilepsy Linked to Early Onset of Puberty in 2-Year-Old2021-05-03
NEW YORK (Reuters Health) – Researchers from the U.K. are reporting a case of early puberty in a 2-year-old boy who was given cannabidiol (CBD) oil his mother purchased online to help control epileptic seizures.
The start of puberty before the age of 9 in boys (precocious puberty) is attributed to premature activation of the hypothalamo-pituitary-gonadal (HPG) axis. Studies on the impact of CBD on the HPG axis have been mixed.
While it is unclear whether this case of precocious puberty is a direct consequence of HPG axis activation by delta-9-tetrahydrocannabinol (THC), “this case demonstrates a temporal association between cannabis use and development of precocious puberty,” Dr. Aditya Krishnan of University Hospitals Birmingham NHS Foundation Trust and colleagues write in BMJ Case Reports.
The 2-year-old presented with signs of early puberty, including genital enlargement and growth of pubic hair, change in body odor and acne, which developed over six months.
Seven months prior to diagnosis, his mother began giving the child CBD oil purchased online for severe refractory epilepsy. She reported that the CBD oil, which was advertised to have <0.4% THC concentration, reduced the number of her son’s daily seizures from over 20 to five.
On clinical examination, the boy’s testicular volume was 5 mL bilaterally and his stretched penile length was 9 cm. Pubertal staging was Tanner stage IV, axillary hair stage II and pubic hair stage III.
Serum testosterone levels were abnormally high at 19 nmol/L (normal <0.9); 17-hydroxyprogesterone levels and thyroid-function tests were normal. A gonadotropin-releasing hormone (GnRH) stimulation test demonstrated a peak luteinizing hormone (LH) response of 31 U/L (normal <4.0) and follicle-stimulating hormone (FSH) level of 6 U/L (normal <2.0).
“The normal urinary steroid profile excluded specific biosynthetic adrenal disorders resulting in increased production of androgens. In addition to raised testosterone, the positive GnRH stimulation test was consistent with the final diagnosis of central precocious puberty,” the authors report.
“The patient was started on triptorelin, a gonadorelin analogue which downregulates GnRH receptors to reduce the effects of LH/FSH, ultimately reducing androgen production,” they report.
“Until a more robust evidence base is established, clinicians should be cautious of hormonal consequences of cannabis-related products,” they conclude.
Dr. Krishnan did not respond to a request for comment by press time.
SOURCE: https://bit.ly/3eiGxqG BMJ Case Reports, online April 15, 2021.
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