Apoplejía hipofisaria inducida por triptorelina en paciente con cáncer de próstata

Guerrero-Pérez, Fernando; Marengo, Agustina Pia; Planas-Vilaseca, Alejandra; Flores-Escobar, Vanesa; Villabona-Artero, Carles

doi:10.1016/j.endonu.2015.05.005

Cited by 7 publications

(8 citation statements)

References 6 publications

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“…Hormonally active tumors, such as acromegaly and Cushing's disease, or large non-functioning tumors are vulnerable to apoplexy. Bromocriptine/cabergoline and GnRH agonist/LHRH agonist are well-characterized precipitating treatments that are used to treat prolactinoma and prostate cancer, respectively [ 2 3 ]. However, most pituitary apoplexy cases lack any known predisposing condition.…”

Section: Discussionmentioning

confidence: 99%

“…Known precipitating factors of pituitary apoplexy include surgery, anticoagulation therapy, and post-partum hemorrhage [ 1 ]. Additionally, bromocriptine, cabergoline, and other pituitary-stimulating treatments, such as gonadotropin-releasing hormone (GnRH) agonist or luteinizing hormone-releasing hormone (LHRH) agonist, have been reported to cause apoplexy [ 2 3 ]. Most cases of pituitary apoplexy occur in the absence of any precipitating factor.…”

Section: Introductionmentioning

confidence: 99%

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Extensive Pituitary Apoplexy after Chemotherapy in a Patient with Metastatic Breast Cancer

Jang

Hong

et al. 2018

Brain Tumor Res Treat

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Surgery, anticoagulation therapy, pregnancy, and hormone treatments, such as bromocriptine, are well-characterized precipitating factors for pituitary apoplexy. However, whether cytotoxic chemotherapy for systemic cancer could cause pituitary apoplexy has not been investigated. Here, we present a case of a 41-year-old woman who developed a severe headache with decreased visual acuity after intravenous cytotoxic chemotherapy to treat metastatic breast cancer. Preoperative neuroimaging revealed pituitary adenoma with necrosis. Operative findings and pathologic examination concluded extensive necrosis with a small intratumoral hemorrhage in a pre-existing pituitary adenoma. We reviewed two additional previously published cases of pituitary apoplexy after systemic chemotherapy and suggest that cytotoxic chemotherapy may induce pituitary apoplexy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Extensive Pituitary Apoplexy after Chemotherapy in a Patient with Metastatic Breast Cancer

Jang

Hong

et al. 2018

Brain Tumor Res Treat

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“…Attending to the frequency of pituitary adenomas in the general population and the widespread use of GnRHa in prevalent diseases such as prostate cancer, along with the fact that pre-treatment pituitary hormone tests or imaging evaluation are probably not cost-effective, it is essential to draw attention to this possible complication (7,8). In patients with a known pituitary adenoma, Babbo et al recommended a thorough clinical evaluation and discussion by a multidisciplinary team including endocrinologists and neurosurgeons: in macroadenomas, surgical resection of the tumor prior to GnRHa therapy may be appropriate (given the higher likelihood of apoplexy in larger tumors), while in microadenomas, it may be suitable to cautiously proceed with GnRHa therapy (7).…”

Section: Discussionmentioning

confidence: 99%

“…The first case recording this condition was reported by Ando et al . in 1995 and since then 20 other cases have been published ( 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ) – Table 2 . Literature analysis of these reports revealed clinical features consistent with PA, highlighting pituitary MRI as the gold standard for diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Androgen deprivation therapy, including gonadotropin-releasing hormone agonists (GnRHa), is administered as primary systemic therapy for regional or advanced prostate cancer and as neoadjuvant/concomitant/adjuvant therapy in combination with radiation in localized or locally advanced disease (2). GnRHa administration for prostate cancer has been reported to induce PA in patients with a concurrent pituitary adenoma, but there are only 21 cases described in the literature to date (3,4,5,6,7,8,9,10). Although it is a rare complication, and since diagnosing PA requires high suspicion index, healthcare professionals should be aware of this association in order to enable an early recognition and adequate treatment.…”

Section: Introductionmentioning

confidence: 99%

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Pituitary apoplexy induced by gonadotropin-releasing hormone agonist administration: a rare complication of prostate cancer treatment

Barbosa

Paredes

Machado

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Gonadotropin-releasing hormone (GnRH) agonists, currently used in the treatment of advanced prostate cancer, have been described as a rare cause of pituitary apoplexy, a potentially life-threatening clinical condition. We report the case of a 69-year-old man with a known pituitary macroadenoma who was diagnosed with prostate cancer and started treatment with GnRH agonist leuprorelin (other hormones were not tested before treatment). Few minutes after drug administration, the patient presented with acute-onset severe headache, followed by left eye ptosis, diplopia and vomiting. Pituitary MRI revealed tumor enlargement and T1-hyperintense signal, compatible with recent bleeding sellar content. Laboratory endocrine workup was significant for low total testosterone. The patient was managed conservatively with high-dose steroids, and symptoms significantly improved. This case describes a rare phenomenon, pituitary apoplexy induced by GnRH agonist. We review the literature regarding this condition: the pathophysiological mechanism involved is not clearly established and several hypotheses have been proposed. Although uncommon, healthcare professionals and patients should be aware of this complication and recognize the signs, preventing a delay in diagnosis and treatment. Learning points: Pituitary apoplexy (PA) is a potentially life-threatening complication that can be caused by gonadotropin-releasing hormone agonist (GnRHa) administration for the treatment of advanced prostate cancer. This complication is rare but should be taken into account when using GnRHa, particularly in the setting of a known pre-existing pituitary adenoma. PA presents with classic clinical signs and symptoms that should be promptly recognized. Patients should be instructed to seek medical care if suspicious symptoms occur. Healthcare professionals should be aware of this complication, enabling its early recognition, adequate treatment and favorable outcome.

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Pituitary apoplexy induced by gonadotropin-releasing hormone (GnRH) agonist administration for treatment of prostate cancer: a systematic review

Raj

Elshimy

Jacob

et al. 2021

J Cancer Res Clin Oncol

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Objective We aimed to review of literature on the clinical presentation, management and outcomes of pituitary apoplexy following gonadotrophic release hormone (GnRH) agonist administration for the treatment of prostate cancer. Methods We used PRISMA guidelines for our systematic review and included all English language original articles on pituitary apoplexy following GnRH agonist administration among prostate cancer patients from Jan 1, 1995 to Dec 31, 2020. Data on patient demographics, prostate cancer type, Gleason score at diagnosis, history of pituitary adenoma, clinical presentation, GnRH agonist, interval to pituitary apoplexy, laboratory evaluation at admission, radiologic findings, treatment of pituitary apoplexy, time to surgery if performed, pathology findings, and clinical/hormonal outcomes were collected and analyzed. Results Twenty-one patients with pituitary apoplexy met our inclusion criteria. The mean age of patients was 70 (60–83) years. Leuprolide was the most common used GnRH agonist, used in 61.9% of patients. Median duration to symptom onset was 5 h (few minutes to 6 months). Headache was reported by all patients followed by ophthalmoplegia (85.7%) and nausea/vomiting (71.4%). Three patients had blindness at presentation. Only 8 cases reported complete anterior pituitary hormone evaluation on presentation and the most common endocrine abnormality was FSH elevation. Tumor size was described only in 15 cases and the mean tumor size was 26.26 mm (18–48 mm). Suprasellar extension was the most common imaging finding seen in 7 patients. 71.4% of patients underwent pituitary surgery, while 23.8% were managed conservatively. Interval between symptoms onset to pituitary surgery was 7 days (1–90 days). Gonadotroph adenoma was most common histopathologic finding. Clinical resolution was comparable, while endocrine outcomes were variable among patients with conservative vs surgical management. Conclusion Although the use of GnRH agonists is relatively safe, it can rarely lead to pituitary apoplexy especially in patients with pre-existing pituitary adenoma. Physicians should be aware of this complication as it can be life threatening. A multidisciplinary team approach is recommended in treating individuals with pituitary apoplexy.

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Apoplejía hipofisaria inducida por triptorelina en paciente con cáncer de próstata

Cited by 7 publications

References 6 publications

Extensive Pituitary Apoplexy after Chemotherapy in a Patient with Metastatic Breast Cancer

Extensive Pituitary Apoplexy after Chemotherapy in a Patient with Metastatic Breast Cancer

Pituitary apoplexy induced by gonadotropin-releasing hormone agonist administration: a rare complication of prostate cancer treatment

Pituitary apoplexy induced by gonadotropin-releasing hormone (GnRH) agonist administration for treatment of prostate cancer: a systematic review

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