Pituitary apoplexy after leuprolide administration for carcinoma of the prostate

Abstract

The syndrome of pituitary apoplexy has been reported to occur after the administration of several different medications. We report a case in which pituitary apoplexy developed shortly after the administration of leuprolide in a patient with prostate cancer. Leuprolide is a potent gonadotrophin releasing hormone (GnRH) analogue used to suppress leuteotrophic hormone (LH) and testosterone levels in patients with metastatic prostate cancer. LH and testosterone levels actually rise in the first week after its administration before becoming suppressed. We suspect that this acute stimulating effect of leuprolide is linked to the acute onset of pituitary apoplexy in a patient with a possible gonadotrophoma.

Protocols for the Use of Cyproterone, Medroxyprogesterone, and Leuprolide in the Treatment of Paraphilia

“…Theoretical work shows this to be a contraindication for leuprolide. This work, supported by a case report, indicates that the initial pituitary stimulation from the first injection ofdepot leuprolide can cause a pituitary adenoma to become symptomatic (17). If this occurs, pituitary apoplexy may result.…”

Pituitary apoplexy after leuprolide

“…To our knowledge, only five cases have been reported of patients developing pituitary apoplexy shortly after initiation of therapy with GnRH analogues, including goserelin and leuprolide [7,8,[10][11][12]. In cases reported, patients have been over age sixty-two and symptoms have started from within minutes of injection up to nine days after injection.…”

“…Stimulation of the pituitary gland through increased estrogen states such as exogenous estrogen administration and pregnancy, dynamic testing of the pituitary with GnRH, TRH or other secretagogues, and other hormonal treatments such as bromocriptine have been reported to cause apoplexy [5]. To our knowledge, there have been only five reported cases of pituitary apoplexy after GnRH agonist therapy [7,8,[10][11][12].…”

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

“…From 1995 to 2009, there were nine reported cases of pituitary apoplexy related to the treatment of prostatic cancer [7][8][9][10][11][12][13][14][15]. There was also a report of pituitary apoplexy which occurred in a 22 year old female who received Leuprolide in conjunction with an ovum donation protocol [16].…”