Should gonadotropin releasing hormone analogue be administered to prevent premature ovarian failure in young women with systemic lupus erythematosus on cyclophosphamide therapy?
A 15 year old girl with acute renal failure was found to have class IV systemic lupus erythematosus (SLE) nephritis on renal biopsy. A decision was taken to start her on the routine National Institute Health protocol of pulsed methyl-prednisolone and monthly intravenous cyclophosphamide (CYC) (0.5–1.0 g/m² of body surface area). With her post pubertal status and the possibility of CYC induced gonadal toxicity, the question was raised as to whether she should be put on gonadotropin releasing hormone analogue ( GnRH-a ) therapy for ovarian protection.

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A four-year old girl presents to the accident and emergency department with a history of being generally unwell for the preceding week and on examination is found to have cervical lymphadenopathy. In addition to a volley of tests, a Lactate Dehydrogenase (LDH) was requested by a registrar who had read that this was a predictor of malignancy which came back as 1,750. Should this be seen as suggestive of underlying malignancy? more…