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

Abstract

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.

Pituitary apoplexy following gonadotropin-releasing hormone agonist administration with gonadotropin-secreting pituitary adenoma

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

“…Symptoms struck most patients in 1 day immediately after first injection of GnRHa, and only two cases had PA onset later on the 9th and 10th days following treatment. Guerra has described this phenomenon as a biphasic phase, with the first peak attacking within 4 h and the second peak delayed even more than 1 week [10]. The exact mechanism of GnRHa-induced PA is still unclear.…”

“…Pathologic findings manifesting ischemia and necrosis are only confined within adenoma, which is compatible with this hypothesis. Unfortunately, this meticulous dual speculation is impractical to be confirmed by pre- and post-apoplexy brain MRI, which makes room for further investigation [10]. …”

“…Six patients underwent surgery after several days of initial presentation, four clients received medical treatment at first then changed to surgery because of poor responses, while the first two reported cases had conservative medical management only [2-5,7-10,13]. The outcomes of PA are variable, as according to the previous reports, one expired due to cardiac arrest, another suffered from disseminated malignant melanoma, and one had persistent complications [4,5,8].…”

Zmiany morfologiczne i enzymatyczne wywołane długoterminowym podawaniem samicom szczura niskiej dawki agonisty i antagonisty gonadoliberyny.

“…However, in patients aged 60–78 years, receiving GnRH agonist goserelin therapy for a long time for metastasizing prostate carcinoma, clinical findings suggestive of proliferative histopathological pituitary changes (partial nodular hyperplasia) were observed [48]. In some cases, in the histopathological examination, the tissues consistent with a gonadotropinoma were recognized after being given a dose of leuprolide and gosereline [49,50]. In these cases hemorrhage within the gland was also observed, but there was no evidence of pituitary dysfunction in hormonal studies.…”