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

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 p...

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Bibliographic Details
Published in:BMJ case reports 2017-07, Vol.2017, p.bcr-2016-218514
Main Authors: Tanios, Georges, Mungo, Nicolas Andrews, Kapila, Aaysha, Bajaj, Kailash
Format: Article
Language:English
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
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Summary: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.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2016-218514