128 REV. HOSP. CLÍN. FAC. MED. S. PAULO 59(3):128-130, 2004 From the Gynecologic Oncology Service, Gynecologic Adolescent Service, Pathology Division and Gynecologic Emergency Service, Hospital das Clínicas, Faculty of Medicine, University of São Paulo - São Paulo/SP, Brazil. E-mail: carvalhojp@uol.com.br Received for publication on July 29, 2003. CASE REPORT ADNEXAL TORSION FOLLOWING GONADOTROPIN- RELEASING HORMONE ANALOG THERAPY: A CASE REPORT Jesus Paula Carvalho, Mara Solange Diegoli, Filomena Marino Carvalho and Carlos Alberto Diegoli CARVALHO JP et al. Adnexal torsion following gonadotropin-releasing hormone analog therapy: a case report. Rev. Hosp. Clín. Fac. Med. S. Paulo 59(3):128-130, 2004. Adnexal torsion may occur in girls and adolescents. Often it is associated with ovarian diseases resulting in ovarian enlargement. Adnexal torsion may involve the ovary, fallopian tube or both, and the main sympton is acute pelvic pain. An 8-year-old girl complaining of acute pelvic and abdominal pain, who was previously diagnosed with precocious puberty and who received treatment with a GnRH analog, is reported. Ultrasound demonstrated a normal-sized uterus and bilaterally enlarged ovaries with multiple internal cysts. At laparotomy, we found a complete torsion in the right adnexa. The histological examination revealed massive edema associated with multiple antral follicles and reduction of the follicular reserve. KEY WORDS: Ovarian neoplasms. Adnexal torsion. Precocious puberty. GnRH analog. Ovarian torsion is an uncommon cause of abdominal pain in children and teenagers. However, in several se- ries of children with ovarian masses, torsion was at least a component of the final diagnosis in 5 to 17 percent of the cases. Torsion of the ovary initially in- terferes with venous and lymphatic cir- culation, so there is sudden growth of the adnexa because of congestion and edema. If the torsion is unrelieved, the arterial supply may eventually be com- promised—a condition that can lead to ovarian necrosis and peritonitis, man- dating early surgical intervention 2 . Adnexal torsion may involve the ovary, fallopian tube, 2 or both. Ovar- ian enlargement of any cause is a pre- disposing condition for adnexal tor- sion. It may occur in any age group, including prepubertal girls, 2-5 and the diagnosis must be included in the dif- ferential diagnosis for girls and teen- agers with acute pelvic pain. The right side is affected more fre- quently than the left 2 . Because symp- toms are nonspecific, the diagnosis may be confused with pelvic inflam- matory disease or appendicitis. 2 Nau- sea and vomiting are frequent symp- toms, and fever and leukocytosis are occasionally present. A case of adnexal torsion follow- ing GnRH analog treatment for preco- cious puberty in a patient with unsus- pected McCune-Albright syndrome is reported. CASE REPORT An eight year girl, height 145 cm, was referred to our hospital complain- ing of acute pelvic and abdominal pain. There was no history of fever, urination changes, weight loss, or diarrhea. In the previous 12 hours she had presented some episodes of nau- sea and vomiting. The mother reported that the girl had experienced breast development since the age of 4. Five months previously, serum estradiol had been measured at 23 pg/ mL. The diagnosis of precocious pu-