Leuprolide‐Induced Myopathy

Gerpen, Jay A. van; McKinley, Kevin L.

doi:10.1046/j.1532-5415.2002.50474.x

Cited by 14 publications

(4 citation statements)

References 2 publications

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“…Both systolic and diastolic blood pressure were decreased following 3 months of Lupron in women and, notably, this was not prevented with oestrogen replacement (44). As indicated earlier, a plethora of evidence suggests that GnRH treatment may be associated with an increased risk of cardiac dysfunction (1–3,45–47). Such phenomenon of compromised heart function accompanying GnRH therapy is usually attributed to the accompanying androgen deprivation (1–3).…”

Section: Discussionmentioning

confidence: 98%

The Heart: A Novel Gonadotrophin-Releasing Hormone Target

Dong

Skinner

et al. 2011

Journal of Neuroendocrinology

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Gonadotrophin-releasing hormone (GnRH) is a hypothalamic hormone transported by the hypophyseal portal bloodstream to the pituitary gland, where it binds to GnRH receptors. However, GnRH receptors are expressed in multiple extrapituitary tissues, although their physiological relevance is not fully understood. GnRH agonists are employed extensively in steroid deprivation therapy, especially to suppress testosterone in prostate cancer. Because GnRH agonist treatment is associated with increased coronary heart disease and myocardial infarction, we investigated the impact of GnRH on cardiomyocyte contractile function. Cardiomyocytes were isolated from mouse hearts and mechanical and intracellular Ca(2+) properties were evaluated, including peak shortening amplitude (PS), time-to-PS (TPS), time-to-90% relengthening (TR(90) ), maximal velocity of shortening/relengthening (± dLdt), electrically-stimulated rise in Fura-2 fluorescence intensity (ΔFFI) and Ca(2+) decay. GnRH (1 ng/ml) increased PS, ± dL/dt, resting FFI and ΔFFI, and prolonged TPS, TR(90) and Ca(2+) decay time, whereas 1 pg/ml GnRH affected all these cardiomyocyte variables, except TPS, resting FFI and ΔFFI. A concentration of 1 fg/ml GnRH and the GnRH cleavage product, GnRH-[1-5] (300 pg/ml), had no effect on any cardiomyocyte parameter. The 1 pg/ml GnRH-elicited responses were attenuated by the GnRH receptor antagonist cetrorelix (10 μm), the protein kinase A (PKA) inhibitor H89 (1 μm) but not the protein kinase C inhibitor chelerythrine chloride (1 μm). These data revealed that GnRH is capable of regulating cardiac contractile function via a GnRH receptor/PKA-dependent mechanism. If present in the human heart, dysfunction of such a system may play an important role in cardiac pathology observed in men treated with GnRH agonists for prostate cancer.

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Section: Discussionmentioning

confidence: 98%

The Heart: A Novel Gonadotrophin-Releasing Hormone Target

Dong

Skinner

et al. 2011

Journal of Neuroendocrinology

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“…This has been observed, for example, in polymyositis caused by leuprolide depot injections for prostate cancer, but has not yet been studied as a potential cause of myositis ossificans or other soft tissue tumors with the use of anabolic steroids. 24 Although further investigation is warranted, myositis ossificans should be considered a complication of anabolic steroid injection.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Deltoid Myositis Ossificans in a Weightlifter Using Anabolic Steroids

Schultzel¹,

Johnson²,

Rosenthal³

2014

Orthopedics

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A 40-year-old male weightlifter presented with a 6-month history of a painless mass in the right deltoid. He had no history of trauma to the shoulder other than an arthroscopic rotator cuff repair a few weeks earlier. Physical examination showed a firm, nontender mass located longitudinally and coinciding with the deltoid, measuring 12×14×4 cm. There was no limitation in range of motion or functioning. Magnetic resonance imaging (MRI) and computed tomography (CT) scans suggested a lobulated, heterogeneous mass with multiple areas of calcification that raised suspicion for soft tissue sarcoma vs myositis ossificans. Marginal resection of the soft tissue mass was performed, and pathologic studies confirmed the diagnosis of xanthogranulomatous myositis ossificans with dystrophic calcifications and central cystic degeneration. At 2-week follow-up, the patient had improved range of motion and pain, but he noted a second soft tissue mass in the left deltoid. The MRI and CT scans showed a 10.5×16×3.4-cm linear, lobulated lesion with multiple calcifications, similar in appearance to the contralateral deltoid. The patient admitted to frequently injecting anabolic steroids into his deltoids. Because the patient was asymptomatic on the left side and the MRI appearance of the left deltoid mass was similar to that of the myositis ossificans seen on the right side, the patient opted for nonsurgical treatment. This is a rare case of myositis ossificans occurring bilaterally in the deltoids after repeated injections of anabolic steroids. There is currently no known association between anabolic steroids and myositis ossificans. This condition often mimics malignant neoplasms, illustrating the necessity of resection for diagnostic confirmation.

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“…The three previously published cases manifested with proximal myopathy. While the muscle biopsy in the first case showed diffuse T-lymphocyte infiltration of the muscle and was treated with steroids [12], the biopsy in the second case revealed only mild, non-specific changes [13]. In the third case, no biopsy was performed [14].…”

Section: Discussionmentioning

confidence: 99%

Inflammatory myopathy and severe rhabdomyolysis induced by leuprolide acetate therapy for prostate cancer: a case report

2011

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IntroductionLeuprolide acetate is a synthetic analog of gonadotropin-releasing hormone used for the treatment of prostate cancer. Its side effects are hot flashes, nausea, and fatigue. We report a case of a patient with proximal inflammatory myopathy accompanied by severe rhabdomyolysis and renal failure following the second application of leuprolide acetate. Drug withdrawal and steroid therapy resulted in remission within six weeks of the diagnosis. To the best of our knowledge, our case report describes the second case of leuprolide acetate-induced inflammatory myopathy and the first case of severe leuprolide acetate-induced rhabdomyolysis and renal failure in the literature.Case presentationA 64-year-old Swiss Caucasian man was admitted to the hospital because of progressive proximal muscle weakness, dyspnea, and oliguria. He had been treated twice with leuprolide acetate in monthly doses. We performed a muscle biopsy, which excluded other causes of myopathy. The patient's renal failure and rhabdomyolysis were treated with rehydration and steroid therapy.ConclusionThe aim of our case report is to highlight the rare but severe side effects associated with leuprolide acetate therapy used to treat patients with inflammatory myopathy: severe rhabdomyolysis and renal failure.

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Leuprolide‐Induced Myopathy

Cited by 14 publications

References 2 publications

The Heart: A Novel Gonadotrophin-Releasing Hormone Target

The Heart: A Novel Gonadotrophin-Releasing Hormone Target

Bilateral Deltoid Myositis Ossificans in a Weightlifter Using Anabolic Steroids

Inflammatory myopathy and severe rhabdomyolysis induced by leuprolide acetate therapy for prostate cancer: a case report

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