Late onset of pituitary apoplexy following gonadotropin-releasing hormone agonist for prostate cancer treatment

Abstract

Pituitary apoplexy (PA) is a clinical condition characterised by a sudden increase in pituitary gland volume secondary to ischaemia and/or necrosis. Most cases occur in non-functioning pituitary adenoma but can also occur in functioning adenoma. Certain predisposing factors can result in PA and the use of gonadotropin-releasing hormone (GnRH) agonists for prostate cancer (PCa) is one such condition. Once diagnosed, both surgical and conservative management has been used for the treatment of PA. We present a case of a man in his late 50s who developed PA following treatment of PCa with leuprolide. His symptoms developed insidiously and he presented 6 months after symptom onset. Anterior pituitary hormone workup along with pituitary MRI confirmed the diagnosis of PA and patient was subsequently treated with adequate replacement of pituitary hormone with significant improvement in his symptoms. It is very important to keep a high index of suspicion for PA, especially among elderly patients receiving GnRH agonist treatment for PCa.

Pituitary Apoplexy After Leuprolide Therapy in a Breast Cancer Patient: A Case Report

“…This report documents a PA case of a GnRH-releasing pituitary adenoma in a breast cancer patient treated with leuprolide. First reported in 1995, PA has been reported in more than 20 patients treated with GnRH agonists [ 4 6 7 ]. Most cases involved prostate cancer patients, who were treated with GnRH agonists.…”

“…Most cases involved prostate cancer patients, who were treated with GnRH agonists. Meanwhile, a few cases involving breast cancer patients have been reported ( Table 2 ) [ 5 6 8 ]. The common time of onset was within 4 hours; however, one reported case of PA was detected 1 year after the administration of the final last dose [ 6 ].…”

“…Meanwhile, a few cases involving breast cancer patients have been reported ( Table 2 ) [ 5 6 8 ]. The common time of onset was within 4 hours; however, one reported case of PA was detected 1 year after the administration of the final last dose [ 6 ]. According to a systemic review reported in 2021, among 12 prostate cancer patients with GnRH agonist-related PA who had undergone surgical treatment, 10 had tumors positive for LH and FSH on immunohistochemistry, while 2 were positive for FSH only, like the patient in the present case [ 4 ].…”