Pituitary apoplexy after leuprolide injection for ovum donation

Engel, Gregory; Huston, Michelle; Oshima, Sachie; Beck, Carter; Harsh, Griffith R.; Rosenthal, Myer H.; Camargo, Carlos A.

doi:10.1016/s1054-139x(02)00372-5

Cited by 21 publications

(7 citation statements)

References 31 publications

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“…Previous studies showed that hyponatremia occurred in 44% of PA cases, as well as the present case [11]. Randeva et al postulated that hyponatremia might correlate with hypocortisolism, hypothyroidism, inappropriate secretion of antidiuretic hormone, or a combination of the above [12].…”

Section: Discussionsupporting

confidence: 75%

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Pituitary apoplexy induced by Gonadotropin-releasing hormone agonists for treating prostate cancer-report of first Asian case

et al. 2013

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We present the first Asian case of a 77-year-old man who developed pituitary apoplexy (PA) soon after gonadotropin-releasing hormone agonist (GnRHa) (leuprorelin) injection to treat prostate cancer. Headache, ophthalmoplegia, visual field deficit, nausea, and vomiting are the typical characteristics of pituitary apoplexy. Though the occurrence rate is rare, the consequence of this condition can vary from mild symptoms such as headache to life-threatening scenarios like conscious change. Magnetic resonance imaging is the best imaging modality to detect PA and sublabial trans-sphenoid pituitary tumor removal can resolve most of PA symptoms and is so far the best solution in consensus. We also review 11 previous reported cases receiving GnRHa for androgen deprivation therapy of prostate cancer, and hope to alert clinicians to use GnRHa with caution.

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Section: Discussionsupporting

confidence: 75%

“…Whether to have every prostate cancer patient have a brain MRI before GnRHa injection is still debatable [4,7,10,11], and is impractical clinically. Intriguingly, a patient underwent adenoma excision while continuously receiving GnRHa injection without the occurrence of PA [9].…”

Section: Discussionmentioning

confidence: 99%

Pituitary apoplexy induced by Gonadotropin-releasing hormone agonists for treating prostate cancer-report of first Asian case

et al. 2013

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“…A history of pituitary tumour was reported in 8.7% of patients, which is a very small proportion. Most cases of cerebral infarction following PA are sudden and may occur without any known trigger; however, some triggers have been proposed, including radiation therapy, bromocriptine therapy, foetation, head injury, anticoagulant therapy, diabetic ketoacidosis, and changes in intracranial cerebrospinal fluid pressure (caused by angiography, lumbar puncture, recurrent cough caused by respiratory tract infection, and general anaesthesia) and in the early postoperative period [13, 15, 19]. Of the patients collected in this study, 21.7% were identified as having predisposing factors for PA, such as angiography, head trauma, fall, pituitary surgery, delivery, leuprolide injection, triple bolus test, anticoagulative and antithrombotic therapy, and pituitary function test [6, 9, 12, 13, 15, 26, 31, 37].…”

Section: Discussionmentioning

confidence: 99%

“…In general, tumours compress unilateral arteries, but 5 cases of bilateral ICA compression [7, 9, 19, 26, 29] and 3 cases of bilateral ACA compression have been reported in the literature [18, 28, 39]. Cerebral vasospasm is another mechanism of cerebral infarction caused by PA [2, 7, 8, 11-13, 15, 17, 18, 21, 22, 27, 28, 31, 32, 40]. First, pituitary tumour haemorrhage enters the subarachnoid space.…”

Section: Discussionmentioning

confidence: 99%

Pituitary Apoplexy Leading to Cerebral Infarction: A Systematic Review

et al. 2020

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Background: Cerebral infarction caused by pituitary apoplexy (PA) is rare. To characterize the clinical features of cerebral infarction caused by PA, we performed a systematic review. Summary: The clinical symptoms are mainly sudden headache, hemiplegia, visual impairment, disturbance of consciousness, and ophthalmalgia in patients with cerebral infarction caused by PA. Treatment for this type of infarction is different from treatment for general acute cerebral infarction. Compared to patients who underwent emergency surgery and conservative treatment, patients treated with delayed surgery showed a better prognosis and a lower mortality rate. Compared to patients who underwent craniotomy or conservative treatment, patients who underwent transsphenoidal surgery (TSS) not only improved well but also showed a lower mortality rate. Key Messages: PA rarely causes cerebral infarction, which is a critical condition with a poor prognosis and is more common in men. Delayed surgery and TSS appear to confer a better prognosis in patients with this condition.

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“…There was also a report of pituitary apoplexy which occurred in a 22 year old female who received Leuprolide in conjunction with an ovum donation protocol [16]. This case report is not included in our review.…”

Section: Description Of Cases In the Literaturementioning

confidence: 99%

Apoplexy in non functioning pituitary adenoma after one dose of leuprolide as treatment for prostate cancer

et al. 2009

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We report the case of a 60 year old male who complained of headache and blurry vision--that progressed to left ophthalmoplegia and ptosis--after receiving a dose of leuprolide for Prostate cancer therapy. Imaging showed a hemorrhagic sellar mass. The patient underwent transsphenoidal debulking, and the tissue obtained demonstrated immunohistochemical staining for LH. A literature review revealed nine previously reported cases of pituitary apoplexy after GnRH agonist therapy for prostate cancer. In most cases, the sellar tissues stained for LH, consistent with a gonadotropinoma. The pathophysiology of these events is unclear, but recent animal models suggest possible explanations. The predominance of gonadotropinomas is important because they do not usually present with hypersecretory symptoms. Particular attention to clinical findings suggestive of a non functioning pituitary tumor in patients receiving GnRH agonist therapy is critical as routine screening with MRI is not practical.

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Pituitary apoplexy after leuprolide injection for ovum donation

Cited by 21 publications

References 31 publications

Pituitary apoplexy induced by Gonadotropin-releasing hormone agonists for treating prostate cancer-report of first Asian case

Pituitary apoplexy induced by Gonadotropin-releasing hormone agonists for treating prostate cancer-report of first Asian case

Pituitary Apoplexy Leading to Cerebral Infarction: A Systematic Review

Apoplexy in non functioning pituitary adenoma after one dose of leuprolide as treatment for prostate cancer

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