Browsing by Author "Saylor P.J."

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    GnRH agonist-associated pituitary apoplexy: a case series and review of the literature
    (Academic Press, 2021) Guarda F.J.; Guarda F.J.; Yu X.; Shiraliyeva N.; Haines M.S.; Nachtigall L.B.; Bradbury M.; Saylor P.J.
    © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.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.