Pituitary apoplexy induced by triptorelin in patient with prostate cancer

Guerrero-Pérez, Fernando; Marengo, Agustina Pia; Planas-Vilaseca, Alejandra; Flores-Escobar, Vanesa; Villabona-Artero, Carles

doi:10.1016/j.endoen.2015.10.003

Cited by 2 publications

(2 citation statements)

References 6 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

View full text Add to dashboard Cite

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“…Case reports have described the occurrence of granulomas at the injection site with GnRH agonist injections , which may be due to the GnRH analogue itself or to another constituent of the formulation . Pituitary apoplexy , interstitial pneumonitis , and anaphylaxis have also all been reported after GnRH agonist administration. These AEs seem to have a low incidence and it remains to be established whether they are connected to a specific agent or represent a class effect of GnRH agonist therapy.…”

Section: Discussionmentioning

confidence: 99%

Are all gonadotrophin‐releasing hormone agonists equivalent for the treatment of prostate cancer? A systematic review

Bolton

Lynch

2018

BJU International

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To review direct comparative studies of the gonadotrophin-releasing hormone (GnRH) agonists goserelin, triptorelin, and leuprorelin for the treatment of prostate cancer, and identify whether there are meaningful clinical differences between these agents. In June 2017, the following searches were performed independently by two reviewers in PubMed: (i) 'prostate cancer' and 'triptorelin' and 'leuprorelin', (ii) 'prostate cancer' and 'triptorelin' and 'goserelin', and (iii) 'prostate cancer' and 'goserelin' and 'leuprorelin', without time restriction. Duplicates were deleted. Relevant conference abstracts were also screened. A total of 16 direct comparative trials were identified: 12 reported on efficacy outcomes, four on safety/tolerability, and five on the convenience of administration/user perceptions. These studies are restricted in terms of patient numbers, formulations assessed, and endpoints measured; none were adequately powered for survival outcome measures. Studies reporting on efficacy endpoints did not show major differences in the ability of these GnRH agonists to reduce levels of testosterone or prostate-specific antigen. Some studies suggest differences in short- or long-term testosterone control, the rate of injection site adverse events, and patient/healthcare professional perceptions, but definitive conclusions cannot be drawn from the existing evidence. Few direct comparative trials of GnRH agonists have been conducted. Whilst GnRH agonists provide a similar castration effect, there is not enough evidence to show that GnRH agonists are equivalent.

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Pituitary apoplexy induced by triptorelin in patient with prostate cancer

Cited by 2 publications

References 6 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

Are all gonadotrophin‐releasing hormone agonists equivalent for the treatment of prostate cancer? A systematic review

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