GnRH agonist-associated pituitary apoplexy: a case series and review of the literature

Guarda, Francisco J; Yu, Xiaoling; Shiraliyeva, Naila; Haines, Melanie S; Saylor, Philip J.; Nachtigall, Lisa B.

doi:10.1007/s11102-021-01143-6

Cited by 4 publications

(6 citation statements)

References 39 publications

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“…Although the exact mechanism of PA following GnRH agonists remain unclear, several mechanisms have been suggested and include: increased tumour vascularity,6 blood supply mismatch,12 increased tumour size resulting in compression of surrounding structure13 14 and cytoskeletal structure changes in gonadotroph cells 15. Majority (up to 62%) of the patients with PA presents within 24 hours of GnRH agonists administration, few cases has been described with presentations up to 6 months after receiving GnRH agonist 6 11. Our patient presented with PA approximately 12 months after receiving leuprolide none the less, he started having symptoms of pituitary hormone deficiency at least 6 months prior to his presentation.…”

Section: Discussionmentioning

confidence: 79%

“…Although PA commonly happen in setting of known pituitary tumours, in over 60% of cases, the underlying lesion can be diagnosed at the time of apoplectic event 10. GnRH agonists are commonly used in the management of patients with PCa and can rarely lead to PA 6 11. In a systematic review by Raj et al , authors reported 21 such cases between 1990 and 2020 with only three cases happening in previously known pituitary adenoma 6.…”

Section: Discussionmentioning

confidence: 99%

“…This suggests an insidious and delayed presentation of our patient’s clinical symptoms of PA, which is extremely uncommon. The most common presentation of PA following GnRH agonist include headache (100%), followed by nausea, vomiting, ophthalmoplegia, visual changes and altered mental status 1 6 11. Few cases of blindness associated with PA in patients receiving GnRH agonist have also been reported 14 16 17.…”

Section: Discussionmentioning

confidence: 99%

“…Consensus regarding appropriate management of PA is unclear and considering course of PA to be variable, management should be individualised. Another systematic review showed that 71% of patient with PA following GnRH were managed surgically while the rest 29% were managed conservatively and found variable clinical and hormonal outcomes following either surgical or conservative management, with none showing superiority over the other 6 11…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2022

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“…In this study, important patient clinical characteristics and outcomes have been described for a relatively large number of patients compared with other case series 5–14. Moreover, the proportion of conservatively managed patients in this cohort (26 patients, 60.5%) is larger than most previously published case series.…”

Section: Discussionmentioning

confidence: 88%

Natural history of pituitary apoplexy: a long-term follow-up study

Shaikh

Williams

Stephens

et al. 2022

Postgraduate Medical Journal

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Background and aimsPituitary apoplexy (PA) is a rare neurosurgical emergency, associated with deficiency of one or more pituitary hormones. Few studies have explored the relative outcomes associated with conservative and neurosurgical intervention.MethodsA retrospective evaluation of all patients with PA reviewed at Morriston Hospital was undertaken and diagnosis was obtained from Morriston database (Leicester Clinical Workstation database) between 1998 and 2019 from clinic letters and discharge summaries.ResultsThirty-nine patients with PA were identified with a mean age of 74.5 years and 20 (51.3%) patients were women. Patients were followed up for a mean±SD 68.1±61.7 months. Twenty-three (59.0%) patients had a known pituitary adenoma. Commoner clinical presentations of PA were ophthalmoplegia or visual field loss. Following PA, 34 (87.2%) patients were noted to have a non-functioning pituitary adenoma (either pre-existing or new), while 5 (12.8%) patients had a pre-existing functional macroadenoma. Neurosurgical intervention was taken in 15 (38.5%) patients of which 3 (20.0%) patients also received radiotherapy, 2 (13.3%) patients had radiotherapy alone and the remainder managed conservatively. External ophthalmoplegia recovered in all cases. Visual loss remained in all cases. One (2.6%) patient with chromophobe adenoma had a significant second episode of PA requiring repeat surgery.ConclusionPA often occurs in patients with undiagnosed adenoma. Hypopituitarism commonly occurred following conservative or surgical treatment. External ophthalmoplegia resolved in all cases, however, visual loss did not recover. Pituitary tumour recurrence and further PA episodes are rare.

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Functioning gonadotroph adenomas in premenopausal women: clinical and molecular characterization and review of the literature

et al. 2022

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GnRH agonist-associated pituitary apoplexy: a case series and review of the literature

Cited by 4 publications

References 39 publications

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

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

Natural history of pituitary apoplexy: a long-term follow-up study

Functioning gonadotroph adenomas in premenopausal women: clinical and molecular characterization and review of the literature

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