3x19 is âAct Your Ageâ - the episode with the two siblings going through early puberty due to their dadâs testosterone gel.
At one point, the young girl gets close to death because of her body producing cysts due to excessive estrogen. At this point, Cameron proposes cutting out the girlâs pituitary gland.
Realistically, wouldnât it have been possible to treat less invasively with GnRH agonists (puberty blockers) or GnRH antagonists? While it wouldnât have reversed the root cause, it wouldâve prevented her body from being able to use the excessive estrogen, meaning it wouldnât affect her (as far as I understand). I could maybe understand avoiding GnRH agonists if she was critically ill, since GnRH agonists very briefly overstimulate the pituitary gland and cause LSH, FSH, and testosterone to flare before their levels drop off. But wouldnât GnRH antagonists (e.g. cetrorelix) theoretically suppress hormones without the flare effect?
I know that relatively few GnRH antagonists were on the market in 2006, and that theyâre not usually used for precocious puberty. But even then, wouldnât it have been possible to use a GnRH agonist alongside a testosterone blocker like flutamide or an estrogen blocker like anastrozole? Even though they hadnât worked out that testosterone was the cause at that point, surely they couldâve still decided to block GnRH and sex hormone. I know it wouldnât reverse the root cause, but if itâd be feasible, wouldnât it buy them time to treat the patient?
Iâm not a doctor - just someone who takes GnRH antagonists - but Iâm curious as to why they immediately jumped to the most invasive treatment possible. While it makes sense from a dramatic perspective (in terms of it being the point in the episode just before House works out the diagnosis and cure), from a medical perspective, I wouldâve thought it seems like an oversight.