Case Report: A diagnostic challenge: rare adverse effects of GnRH analogue therapy in a late pubertal pediatric patient.

We present the case of a 12-year-old post-menarchal female (bone age: 13 years; 30th percentile for height) who received an initial gonadotropin-releasing hormone (GnRH) analogue injection for height augmentation to maximize adult height potential prior to imminent epiphyseal fusion. Immediately following the injection, she developed acute-onset abdominal pain, emesis, and diarrhea. Refractory to conservative management, her clinical status prompted pelvic ultrasonography and subsequent contrast-enhanced CT imaging, which revealed significant bilateral ovarian enlargement, multiple cystic masses, and congestion of the left vascular pedicle highly indicative of adnexal torsion. Urgent surgical exploration confirmed bilateral ovarian cyst formation and left-sided ovarian torsion. Following an unremarkable post-operative recovery, GnRH analogue therapy was permanently discontinued. This case underscores the critical need to recognize the heightened risk of rapid ovarian hyperstimulation and subsequent torsion when initiating these medications in post-menarchal or late pubertal females, in whom mature follicles are already present. While GnRH analogues generally maintain a favorable safety profile, clinician vigilance regarding this severe ovarian complication in older pediatric cohorts is vital to prevent diagnostic delays and ensure prompt surgical intervention.