Pituitary apoplexy: a rare complication of leuprolide therapy in prostate cancer treatment

• Published in: BMJ case reports Vol. 2017; p. bcr-2016-218514
• Main Authors: Tanios, Georges, Mungo, Nicolas Andrews, Kapila, Aaysha, Bajaj, Kailash
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 14-07-2017; BMJ Publishing Group
• Series: Case Report
• Subjects: 80 years; Aged, 80 and over; Androgens; Antineoplastic Agents, Hormonal - adverse effects; Breast cancer; Cancer therapies; Cardiovascular disease; Case reports; Diabetes; Diagnosis, Differential; Family medical history; Growth hormones; Headache - chemically induced; Headache - diagnosis; Headaches; Humans; Immunotherapy; Laboratories; Leuprolide - adverse effects; Literature reviews; Magnetic Resonance Imaging; Male; Mortality; Patients; Pituitary Apoplexy - chemically induced; Pituitary Apoplexy - diagnosis; Pituitary Apoplexy - diagnostic imaging; Prostate cancer; Prostatic Neoplasms - drug therapy; Surgery; Tumors; Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions; USA/Canada; White; Pituitary disorders; Prostate Cancer; Endocrine system; Contraindications and precautions; Drugs: endocrine system
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2016-218514

Gonadotropin-releasing hormone agonists, used widely in the treatment of metastatic prostate cancer and hormone receptor-positive breast cancer, are associated with a rare but potentially fatal outcome of pituitary apoplexy (PA). An 85-year-old man presented with sudden onset of headache, left eye pain, sensitivity to light, nausea and vomiting. The symptoms started 4 hours after initiation of leuprolide therapy for treatment of recently diagnosed metastatic prostate carcinoma. Radiological imaging of the brain demonstrated a heterogeneously enlarged pituitary gland measuring 19×16×13 mm and T1-hyperintense signal compatible with pituitary haemorrhage. Hormone function tests were indicative of panhypopituitarism, confirming the diagnosis of PA. Due to age, the patient was started on hormonal replacement therapy and eventually symptoms improved.