Early puberty in 2 year kid caused by CBD oil used for seizures: Case report
Dr. Aditya Krishnan of the University Hospitals Birmingham NHS Foundation Trust in England and colleagues have reported a case of development of puberty in a 2 year old who was given CBD oil for his epileptic seizures.
The case of infant who developed central precocious puberty temporally associated with the use of cannabis oil purchased online has been published in the BMJ case reports.
CBD also known as cannabidiol is derived from hemp that does not cause excitation as much as the marijuana.
According to the history, boy presented with features of precocious puberty, including genital virilisation over the past 6 months. He was known to have severe uncontrolled epilepsy associated with a de novo SCN2A c.743T>C p.
The patient reportedly had over 20 seizures daily since birth, with the frequency worsening over time. Phenytoin, pyridoxal phosphate, carbamazepine, topiramate, lamotrigine, clobazam and a ketogenic diet had been trialled
in the past with limited success. The patient's mother administered cannabidiol oil purchased on the internet without a prescription, which reportedly reduced his seizure frequency to five daily. He continued using this oil, advertised to have <0.4% delta-9-tetrahydrocannabinol (Δ9-ÂTHC) concentration, for 7 months prior to presenting.
The patient's mother reported growth of coarse pubic hair, change in body odour, factruncal acne and an enlarging penis over the past 6 months.
On clinical examination, his 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.
On investigation it was found that the patient's serum testosterone levels were raised at 19 nmol/L (normal <0.9). 17-Hydroxyprogesterone levels and thyroid function tests were normal. The urinary steroid profile showed a ratio of androgen:cortisol metabolites which were high for his age with an otherwise normal profile. His bone age was equal to his chronological age, which is an atypical finding in central precocious puberty.
A gonadotropin-releasing hormone (GnRH) stimulation test demonstrated a peak luteinising hormone (LH) response of 31 U/L (normal <4.0) and follicle stimulating hormone
(FSH) level of 6 U/L (normal <2.0). Urine toxicology assay demonstrated the presence of Δ9-ÂTHC and cannabidiol(CBD). MRI showed thinning of the corpus callosum and a slight hypoplasia of the cerebellum, but no hypothalamicbhamartomas, gross structural sellar or parasellar abnormalities were visualised.
The patient was started on triptorelin, a gonadorelin analogue which downregulates GnRH receptors to reduce the effects of LH/FSH, ultimately reducing androgen production.
In recent years years, cannabis and cannabis-related products have been increasingly considered for the treatment of paediatric onset epilepsy.
However, studies determining the impact of these products on the hypothalamo-pituitary-gonadal (HPG) axis have shown conflicting results.
While animal models have shown cannabis to down regulate androgens, recent human studies have demonstrated raised serum testosterone levels in long-term cannabis users.
No previous cases of precocious puberty associated with cannabinoid use have been reported, with no existing evidence investigating the effects of cannabinoids on infants.
Source- BMJ case reports
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