Case ReportPituitary apoplexy following gonadotropin-releasing hormone agonist administration with gonadotropin-secreting pituitary adenoma
Introduction
Gonadotropin-releasing hormone (GnRH) agonists have become the a common treatment for prostate cancer, premenopausal breast cancer, and myoma of the uterus [1]. We encountered a patient with a pituitary macroadenoma who developed pituitary apoplexy following administration of a GnRH agonist for the treatment of prostate cancer.
Section snippets
Case report
A 62-year-old man was initially evaluated for an elevated prostate specific antigen level of 7.5 ng/mL (normal range 0–4 ng/mL). A transrectal ultrasound guided biopsy of the prostate gland revealed adenocarcinoma. Whole-body 18F-fluorodeoxyglucose positron emission tomography/CT scan for the detection of metastatic lesions showed uptake in the pituitary region. MRI demonstrated a 22 mm pituitary tumor extending into the sphenoid sinus without compressing the optic chiasm (Fig. 1A). His basal
Discussion
Fifteen patients, including the current one, have been reported to have suffered pituitary apoplexy after GnRH agonist administration (Table 1) [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. All reported patients had a gonadotropin secreting macroadenoma. Pituitary apoplexy developed within 4 hours after the administration of the agents in 8/15 patients. All patients experienced severe headache as the first clinical sign and progressive symptoms (visual disturbance,
Conclusion
The combined data suggest that GnRH agonists have the potential to precipitate pituitary apoplexy in men with gonadotropin-secreting adenoma. When GnRH agonist therapy is planned for a patient with a known pituitary adenoma, the pituitary adenoma should be treated prior to GnRH agonist administration. Otherwise, the patient should be observed cautiously for any symptomatic change following drug administration.
Conflicts of Interest/Disclosures
The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
References (15)
- et al.
Pituitary apoplexy after goserelin
Lancet
(1995) - et al.
Pituitary apoplexy after leuprolide injection for ovum donation
J Adolesc Health
(2003) - et al.
Gonadotropin-releasing hormone agonist-induced pituitary apoplexy in treatment of prostate cancer: case report and review of literature
Endocr Pract
(2007) - et al.
Delayed pituitary apoplexy in patient with advanced prostate cancer treated with gonadotrophin-releasing hormone agonists
J Clin Neurosci
(2010) Unexpected enlargement of clinically silent pituitary gonadotroph adenoma induced by goserelin acetate given as treatment for prostate cancer
Int J Urol
(2011)- et al.
Pituitary apoplexy caused by GnRH-agonist treatment revealing gonadotroph adenoma
J Clin Endocrinol Metab
(1995) - et al.
Pituitary apoplexy after leuprolide administration for carcinoma of the prostate
Clin Endocrinol (Oxf)
(1996)
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What to Do with Incidentally Discovered Pituitary Abnormalities?
2021, Medical Clinics of North AmericaCitation Excerpt :Apoplexy may be precipitated by surgery, hemodynamic instability, or anticoagulation. Cases due to gonadotropin-releasing hormone agonist initiation have been reported, but its use is not contraindicated in patients with pituitary adenomas.93,94 The pituitary incidentaloma rate as determined by imaging is high—close to 1 in 5 individuals.
Pituitary Apoplexy
2021, Endocrine EmergenciesPituitary Apoplexy After Initial Leuprolide Injection
2016, World NeurosurgeryCitation Excerpt :Davis et al.1 described this phenomenon in a similar clinical scenario in which a man with prostate cancer developed a pituitary hemorrhage and apoplexy after initial leuprolide administration. The other published reports of pituitary apoplexy after initial leuprolide administration occurred in the presence of an underlying pituitary adenoma, in a man receiving therapy for prostate cancer11 and a woman undergoing a leuprolide injection for ovum donation.12 Our patient presented with a constellation of symptoms and neuroimaging findings consistent with pituitary apoplexy.
Pituitary apoplexy induced by triptorelin in patient with prostate cancer
2015, Endocrinologia y Nutricion