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

Sasagawa, Yasuo; Tachibana, Osamu; Nakagawa, Atsushi; Koya, Daisuke; Iizuka, Hideaki

doi:10.1016/j.jocn.2014.08.015

Cited by 23 publications

(11 citation statements)

References 15 publications

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“…This has been reported in the setting of functional and non-functional pituitary adenomas 6 7. For this reason, though there are limited cases reported regarding this, it is imperative to make the patient aware of these risks, have a heightened sensitivity to the initial signs and symptoms and to adopt a multidisciplinary approach in treatment of these rare cases.…”

Section: Discussionmentioning

confidence: 79%

Prostate cancer: endogenous chemical castration

2016

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We report treatment of intermediate risk prostate cancer in a patient with a brief period of androgen deprivation secondary to a pituitary adenoma. This was a patient with intermediate risk prostate cancer diagnosed in the setting of an elevated prostate-specific antigen (PSA). The patient subsequently demonstrated a decline in PSA along with symptoms of hypogonadism and visual disturbance, and was consequently found to have a pituitary tumour. Trans-sphenoidal resection of the sellar mass was performed with normalisation of hormone profiles. The patient subsequently completed a course of radiation therapy for prostate cancer with PSA nadir to undetectable levels without evidence of biochemical recurrence at 7 months follow-up.

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Section: Discussionmentioning

confidence: 79%

Prostate cancer: endogenous chemical castration

2016

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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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“…GnRH antagonist also used for prostate cancer may be a safer alternative considering PA risk in patients harboring pituitary adenomas (22). Other uncommon risk factors as high altitude (23) and hemorrhagic dengue (24) were recently described.…”

Section: Physiopathologymentioning

confidence: 99%

Pituitary apoplexy: pathophysiology, diagnosis and management

Glezer

Bronstein

2015

Arch. Endocrinol. Metab.

112

108

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Pituitary apoplexy is characterized by sudden increase in pituitary gland volume secondary to is chemia and/or necrosis, usually in a pituitary adenoma. Most cases occur during the 5 th decade of life, predominantly in males and in previously unknown clinically non functioning pituitary adeno mas. There are some predisposing factors as arterial hypertension, anticoagulant therapy and major surgery. Clinical picture comprises headache, visual impairment, cranial nerve palsies and hypopitui tarism. Most cases improve with both surgical and expectant management and the best approach in the acute phase is still controversial. Surgery, usually by transsphenoidal route, is indicated if cons ciousness and/or vision are impaired, despite glucocorticoid replacement and electrolyte support. Pi tuitary function is impaired in most patients before apoplexy and ACTH deficiency is common, which makes glucocorticoid replacement needed in most cases. Pituitary deficiencies, once established, usually do not recover, regardless the treatment. Sellar imaging and endocrinological function must be periodic reevaluated. Arch Endocrinol Metab. 2015;59(3):259-64

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

Cited by 23 publications

References 15 publications

Prostate cancer: endogenous chemical castration

Prostate cancer: endogenous chemical castration

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

Pituitary apoplexy: pathophysiology, diagnosis and management

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