Gonadotropin-releasing hormone agonist-induced pituitary apoplexy

Keane, Fergus; Egan, Aoife M.; Navin, Patrick J.; Brett, Francesca; Dennedy, Michael Conall

doi:10.1530/edm-16-0021

Cited by 11 publications

(8 citation statements)

References 11 publications

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“…We identified a total of 66 published articles between 1995 and 2020 on database search and 21 cases fulfilled inclusion criteria (Ando et al 1995;Chanson and Schaison 1995;Morsi et al 1996;Reznik et al 1997;Eaton et al 2001;Spengos et al 2002;Blaut et al 2006;Davis et al 2006;Massoud et al 2006;Hands et al 2007;Guerra et al 2010;Sinnadurai et al 2010;Ito 2011;Huang et al 2013;Babbo et al 2014;Guerrero-Pérez et al 2015;Sasagawa et al 2015;Fabiano and George 2016;Keane et al 2016;Tanios et al 2017;Barbosa et al 2020). The mean age of the patients was 70 years.…”

Section: Resultsmentioning

confidence: 99%

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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Section: Resultsmentioning

confidence: 99%

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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“…There are several case reports of pituitary apoplexy with the use of GnRH. It was found that these agents may accelerate the growth of asymptomatic pituitary adenomas and cause haemorrhage/infarction ( 10 ). However, this was not a part of our patient’s presentation.…”

Section: Discussionmentioning

confidence: 99%

A very rare case of pituitary metastasis infiltrating a non-secretory gonadotroph adenoma

Darrat

Binhussein

Beausang

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Pituitary adenomas are the commonest sellar tumours. Pituitary metastases are very rare, with the most common primaries being breast and lung cancers. We report the case of an 83-year-old man with a history of breast carcinoma who presented with recent-onset headaches and progressive deterioration of visual acuity. MRI brain showed a large sellar and suprasellar mass compressing the optic chiasm and involving the pituitary stalk. Transsphenoidal debulking resulted in symptomatic relief and visual recovery. Specimen examination revealed a combination of a gonadotroph pituitary adenoma that was infiltrated by metastatic breast carcinoma. He had no symptoms of diabetes insipidus. He was subsequently treated with pituitary radiotherapy. This is a very rare presentation of a pituitary mass with mixed pathology. To our knowledge, this is the third description of a breast carcinoma metastasis into a gonadotroph cell pituitary adenoma. Highlight points: Infiltrating metastases into pituitary adenomas are very rare but do occur. To our knowledge this is the third case of breast adenocarcinoma metastasising to a gonadotroph pituitary adenoma. Pituitary metastases should always be considered in rapidly evolving pituitary symptoms in a cancer patient. Not all complex pituitary lesions are associated with panhypopituitarism. Early invasive local management (TSS and post TSS radiotherapy) can provide rapid satisfactory outcomes.

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“…Increased estrogen states, such as exogenous estrogen administration, pregnancy, and postpartum period, have been reported to cause PA [33,[36][37][38]. Treatment with GnRH agonists for prostate cancer has also been associated with PA [39][40][41].…”

Section: Imbalance Between the Stimulation Of The Pituitary And The Amentioning

confidence: 99%

Pituitary Apoplexy

Jemel¹,

Alaya²,

Boubaker³

et al. 2019

Pituitary Diseases

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Pituitary apoplexy is a rare clinical emergency due to acute ischemic infarction or hemorrhage of the pituitary gland. As this disorder most often involves a pituitary adenoma, especially nonfunctioning tumors, the syndrome should be referred to as pituitary tumor apoplexy. The precise physiopathology is not completely clear. Although in most cases it occurs spontaneously, pituitary apoplexy can be precipitated by many risk factors. The main symptom is headache of sudden onset associated with visual disturbances, signs of meningeal irritation, and/or endocrine dysfunction. Corticotropic deficiency is a potentially life-threatening disorder. Magnetic resonance imaging is the most sensitive to confirm the diagnosis by revealing a pituitary tumor with hemorrhagic and/or necrotic components. Earlier studies used to consider urgent decompression of the lesion surgically, but nowadays, more recent studies favor conservative management in selected patients (those without important visual acuity or field defects and with normal consciousness). This wait-and-see approach gives evidence of excellent outcomes in terms of oculomotor palsy, pituitary function, and subsequent tumor growth. Surgical decompression may be necessary in some cases. Once the acute phase is over, the patient should be reevaluated for hormonal deficiencies. Moreover, spontaneous remission of syndromes, such as acromegaly, may be caused by pituitary adenoma apoplexy.

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Gonadotropin-releasing hormone agonist-induced pituitary apoplexy

Cited by 11 publications

References 11 publications

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

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

A very rare case of pituitary metastasis infiltrating a non-secretory gonadotroph adenoma

Pituitary Apoplexy

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