Apoplexy in non functioning pituitary adenoma after one dose of leuprolide as treatment for prostate cancer.
We report the case of a 60 year old male who complained of headache and blurry vision--that progressed to left ophthalmoplegia and ptosis--after receiving a dose of leuprolide for Prostate cancer therapy. Imaging showed a hemorrhagic sellar mass. The patient underwent transsphenoidal debulking, and the tissue obtained demonstrated immunohistochemical staining for LH. A literature review revealed nine previously reported cases of pituitary apoplexy after GnRH agonist therapy for prostate cancer. In most cases, the sellar tissues stained for LH, consistent with a gonadotropinoma. The pathophysiology of these events is unclear, but recent animal models suggest possible explanations. The predominance of gonadotropinomas is important because they do not usually present with hypersecretory symptoms. Particular attention to clinical findings suggestive of a non functioning pituitary tumor in patients receiving GnRH agonist therapy is critical as routine screening with MRI is not practical.
Hospital of Cook County/Rush University Medical Center, Chicago, IL, USA. yannisguerra@yahoo.com
Yannis
Y
Guerra
Evelyn
E
Lacuesta
Francisco
F
Marquez
P B
PB
Raksin
Manuel
M
Utset
Leon
L
Fogelfeld
D000236:Adenoma / Q000150:complications* / Q000175:diagnosis; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D016729:Leuprolide / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications*; D011471:Prostatic Neoplasms / Q000150:complications / Q000188:drug therapy; D012658:Sella Turcica; D020521:Stroke / Q000139:chemically induced*
D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide