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GnRH agonist-associated pituitary apoplexy: a case series and review of the literature.
Pituitary. 2021 Oct; 24(5):681-689.P

Abstract

PURPOSE

To examine the clinical presentation and longitudinal outcome of Pituitary Apoplexy (PA) after gonadotropin-releasing hormone agonist (GnRHa) in a series of patients and compare to prior reports.

METHODS

A retrospective chart review was performed on seven patients receiving GnRHa who developed PA. Prior reported cases were analyzed.

RESULTS

Six men (median age 72 years) with prostate cancer and one woman (aged 22 years) undergoing oocyte donation presented with PA between 1990 and 2020. Most presented with within 24 h of the first dose, but two developed PA 1 to 5 months after GnRHa initiation. The main clinical manifestations were headache (100%), nausea and vomiting (86%). While no patients had a previously known pituitary tumor, all had imaging demonstrating sellar mass and/or hemorrhage at presentation. Among those surgically treated (5/7), 80% (4/5) of patients had pathologic specimens that stained positive for gonadotropins; the remaining patient's pathologic specimen was necrotic. At the time of PA, the most common pituitary dysfunction was hypocortisolism. Central adrenal insufficiency and central hypothyroidism were reversible in a subset. Pituitary imaging remained stable.

CONCLUSIONS

This is the first report of a case series with PA after GnRHa administration with longitudinal follow-up. Although infrequent, PA can be life-threatening and should be suspected among patients receiving GnRHa, with or without a known pituitary adenoma, who develop acute headache, nausea and/or vomiting. Since hypopituitarism was reversible in a subset, ongoing pituitary function testing may be indicated.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Guarda FJ
Department of Endocrinology and Center for Translational Endocrinology (CETREN-UC), School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. Pituitary Tumor Program. Red de Salud UC-CHRISTUS, Santiago, Chile.
Yu X
Neuroendocrine Unit, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, 100 Blossom Street, Cox140, Boston, MA, 02114, USA.
Shiraliyeva N
Neuroendocrine Unit, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, 100 Blossom Street, Cox140, Boston, MA, 02114, USA.
Haines MS
Neuroendocrine Unit, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, 100 Blossom Street, Cox140, Boston, MA, 02114, USA.
Bradbury M
Department of Ophthalmology, University of Massachusetts Medical Center, Worcester, MA, USA.
Saylor PJ
Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, MA, USA.
Nachtigall LB
Neuroendocrine Unit, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, 100 Blossom Street, Cox140, Boston, MA, 02114, USA. lnachtigall@partners.org.

MeSH

AdenomaAgedFemaleGonadotropin-Releasing HormoneHumansMalePituitary ApoplexyPituitary NeoplasmsRetrospective Studies

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

33835355

Citation

Guarda, Francisco J., et al. "GnRH Agonist-associated Pituitary Apoplexy: a Case Series and Review of the Literature." Pituitary, vol. 24, no. 5, 2021, pp. 681-689.
Guarda FJ, Yu X, Shiraliyeva N, et al. GnRH agonist-associated pituitary apoplexy: a case series and review of the literature. Pituitary. 2021;24(5):681-689.
Guarda, F. J., Yu, X., Shiraliyeva, N., Haines, M. S., Bradbury, M., Saylor, P. J., & Nachtigall, L. B. (2021). GnRH agonist-associated pituitary apoplexy: a case series and review of the literature. Pituitary, 24(5), 681-689. https://doi.org/10.1007/s11102-021-01143-6
Guarda FJ, et al. GnRH Agonist-associated Pituitary Apoplexy: a Case Series and Review of the Literature. Pituitary. 2021;24(5):681-689. PubMed PMID: 33835355.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - GnRH agonist-associated pituitary apoplexy: a case series and review of the literature. AU - Guarda,Francisco J, AU - Yu,Xiaoling, AU - Shiraliyeva,Naila, AU - Haines,Melanie S, AU - Bradbury,Michael, AU - Saylor,Philip J, AU - Nachtigall,Lisa B, Y1 - 2021/04/09/ PY - 2021/03/19/accepted PY - 2021/4/10/pubmed PY - 2022/1/18/medline PY - 2021/4/9/entrez KW - GnRH agonists KW - Hypopituitarism KW - Pituitary apoplexy KW - Pituitary tumors KW - Prostate cancer treatment SP - 681 EP - 689 JF - Pituitary JO - Pituitary VL - 24 IS - 5 N2 - PURPOSE: To examine the clinical presentation and longitudinal outcome of Pituitary Apoplexy (PA) after gonadotropin-releasing hormone agonist (GnRHa) in a series of patients and compare to prior reports. METHODS: A retrospective chart review was performed on seven patients receiving GnRHa who developed PA. Prior reported cases were analyzed. RESULTS: Six men (median age 72 years) with prostate cancer and one woman (aged 22 years) undergoing oocyte donation presented with PA between 1990 and 2020. Most presented with within 24 h of the first dose, but two developed PA 1 to 5 months after GnRHa initiation. The main clinical manifestations were headache (100%), nausea and vomiting (86%). While no patients had a previously known pituitary tumor, all had imaging demonstrating sellar mass and/or hemorrhage at presentation. Among those surgically treated (5/7), 80% (4/5) of patients had pathologic specimens that stained positive for gonadotropins; the remaining patient's pathologic specimen was necrotic. At the time of PA, the most common pituitary dysfunction was hypocortisolism. Central adrenal insufficiency and central hypothyroidism were reversible in a subset. Pituitary imaging remained stable. CONCLUSIONS: This is the first report of a case series with PA after GnRHa administration with longitudinal follow-up. Although infrequent, PA can be life-threatening and should be suspected among patients receiving GnRHa, with or without a known pituitary adenoma, who develop acute headache, nausea and/or vomiting. Since hypopituitarism was reversible in a subset, ongoing pituitary function testing may be indicated. SN - 1573-7403 UR - https://www.unboundmedicine.com/medline/citation/33835355/GnRH_agonist_associated_pituitary_apoplexy:_a_case_series_and_review_of_the_literature_ DB - PRIME DP - Unbound Medicine ER -