Pituitary apoplexy after leuprolide injection for ovum donation.
Patients with occult pituitary adenomas infrequently present with pituitary apoplexy. Precipitation of pituitary apoplexy by gonadotropin releasing hormone or gonadotropin releasing hormone agonists has been described. The pathophysiologic mechanism by which these agents induce apoplexy remains unclear. We describe a case of pituitary apoplexy in a young woman receiving leuprolide in preparation for ovum donation. Severe hyponatremia, cerebral vasospasm and infarction, and diabetes insipidus complicated this patient's prolonged hospital course. To our knowledge, pituitary apoplexy after gonadotropin releasing hormone agonist use for ovum donation has not been previously described. The use of leuprolide or other gonadotropin releasing hormone agonists for pituitary down-regulation in conjunction with ovarian stimulation can have serious consequences in women harboring unrecognized pituitary adenomas. Thorough endocrine screening should be performed prior to initiating therapy.
Engel
Gregory
G
Department of Internal Medicine, Stanford University School of Medicine, Stanford, California 94305, USA. gengel@stanford.edu
Huston
Michelle
M
Oshima
Sachie
S
Beck
Carter
C
Harsh
Griffith
G
Rosenthal
Myer H
MH
Camargo
Carlos A
CA
D000328:Adult; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects*; D006801:Humans; D066298:In Vitro Techniques; D016729:Leuprolide / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D018587:Oocyte Donation; D010899:Pituitary Apoplexy / Q000139:chemically induced* / Q000175:diagnosis; D014481:United States
D005300:Fertility Agents, Female; D016729:Leuprolide