scholarly journals Pituitary apoplexy induced by gonadotropin-releasing hormone (GnRH) agonist administration for treatment of prostate cancer: a systematic review

2021 ◽  
Author(s):  
Rishi Raj ◽  
Ghada Elshimy ◽  
Aasems Jacob ◽  
P. V. Akhila Arya ◽  
Dileep C. Unnikrishnan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Pituitary Adenoma ◽  
Gnrh Agonist ◽  
Tumor Size ◽  
Pituitary Apoplexy ◽  
Clinical Presentation ◽  
Pituitary Surgery ◽  
Laboratory Evaluation ◽  
The Mean

Abstract Objective We aimed to review of literature on the clinical presentation, management and outcomes of pituitary apoplexy following gonadotrophic release hormone (GnRH) agonist administration for the treatment of prostate cancer. Methods We used PRISMA guidelines for our systematic review and included all English language original articles on pituitary apoplexy following GnRH agonist administration among prostate cancer patients from Jan 1, 1995 to Dec 31, 2020. Data on patient demographics, prostate cancer type, Gleason score at diagnosis, history of pituitary adenoma, clinical presentation, GnRH agonist, interval to pituitary apoplexy, laboratory evaluation at admission, radiologic findings, treatment of pituitary apoplexy, time to surgery if performed, pathology findings, and clinical/hormonal outcomes were collected and analyzed. Results Twenty-one patients with pituitary apoplexy met our inclusion criteria. The mean age of patients was 70 (60–83) years. Leuprolide was the most common used GnRH agonist, used in 61.9% of patients. Median duration to symptom onset was 5 h (few minutes to 6 months). Headache was reported by all patients followed by ophthalmoplegia (85.7%) and nausea/vomiting (71.4%). Three patients had blindness at presentation. Only 8 cases reported complete anterior pituitary hormone evaluation on presentation and the most common endocrine abnormality was FSH elevation. Tumor size was described only in 15 cases and the mean tumor size was 26.26 mm (18–48 mm). Suprasellar extension was the most common imaging finding seen in 7 patients. 71.4% of patients underwent pituitary surgery, while 23.8% were managed conservatively. Interval between symptoms onset to pituitary surgery was 7 days (1–90 days). Gonadotroph adenoma was most common histopathologic finding. Clinical resolution was comparable, while endocrine outcomes were variable among patients with conservative vs surgical management. Conclusion Although the use of GnRH agonists is relatively safe, it can rarely lead to pituitary apoplexy especially in patients with pre-existing pituitary adenoma. Physicians should be aware of this complication as it can be life threatening. A multidisciplinary team approach is recommended in treating individuals with pituitary apoplexy.

scholarly journals Metastasis of a Dorsal Melanoma to a Pituitary Adenoma Mimicking Pituitary Apoplexy

2017 ◽  
Vol 36 (04) ◽  
pp. 238-242
Author(s):  
Rui Ramos ◽  
Maria Machado ◽  
Cristiano Antunes ◽  
Vera Fernandes ◽  
Olinda Marques ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pituitary Adenoma ◽  
Adjuvant Radiotherapy ◽  
Transsphenoidal Surgery ◽  
Pituitary Apoplexy ◽  
Clinical Presentation ◽  
Pituitary Macroadenoma ◽  
Histology Result ◽  
History Of ◽  
Transcranial Approach

AbstractMetastases to pituitary adenomas are very rare. From the 20 cases found in the literature, none originated from a cutaneous melanoma. We present the case of a 67-year-old man with a history of transcranial approach to treat a pituitary macroadenoma followed by adjuvant radiotherapy. Fifteen years later, he presented a dorsal nodular melanoma, and three years after that, he developed symptoms of pituitary apoplexy. He was submitted to transsphenoidal surgery, and the histology result revealed metastasis of the melanoma into a pituitary adenoma.The similarity in the clinical presentation of the two entities—pituitary apoplexy and metastasis of the melanoma into a pituitary adenoma—and the rarity of this type of metastization alert to challenges in the differential diagnosis that may confound the neurosurgeon's decision.

scholarly journals Switching from a GnRH agonist to a GnRH antagonist in prostate cancer patients: A systematic review and meta-analysis

2019 ◽  
Vol 14 (2) ◽  
Author(s):  
Kaleem S. Atchia ◽  
Christopher J.D. Wallis ◽  
Neil Fleshner ◽  
Paul Toren
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Meta Analysis ◽  
Specific Antigen ◽  
Patient Characteristics ◽  
Agonist Therapy ◽  
Clinical Responses ◽  
Key Terms

Introduction: We sought to address whether there are clinical responses when patients who are failing gonadotropin-releasing hormone (GnRH) agonist therapy are switched to degarelix. Androgen-deprivation therapy remains the backbone of treatment for disseminated prostate cancer and may be achieved with orchiectomy, GnRH agonists, or degarelix, a GnRH antagonist. Methods: To perform a systematic review and meta-analysis, a search of the BIOSIS Previews, Embase, International Pharmaceutical Abstracts, MEDLINE, and Google Scholar databases was performed using key terms. Quantitative meta-analysis was performed to provide a pooled estimate of prostate-specific antigen (PSA) response at three months. Results: Thirteen studies were identified, eight of which were included in the qualitative and quantitative analyses. Patient characteristics were broadly similar between the studies. Out of 155 patients across all included studies, 20 had stable PSA after the switch (12.9%), 14 had between 10‒30% decrease in PSA (9.0%), three had between 30‒50% decrease (1.9%), and 13 had more than 50% decrease (8.4%). Random effects meta-analysis of these data demonstrated a pooled response rate of 27.75 (95% confidence interval 18.9‒36.5%; I2=7.9%). Changes in testosterone levels following the switch could not be quantitatively assessed due to lack of sufficient data. Conclusions: Our results suggest that a switch to GnRH antagonist following progression on a GnRH agonist may result in a stable or decreased PSA at three months in about 30% of patients. This information should be considered among the potential options to discuss with patients with a rising PSA on GnRH agonist therapy.

scholarly journals Reoperation for growth hormone–secreting pituitary adenomas: report on an endonasal endoscopic series with a systematic review and meta-analysis of the literature

2018 ◽  
Vol 129 (2) ◽  
pp. 404-416 ◽  
Author(s):  
João Paulo Almeida ◽  
Armando S. Ruiz-Treviño ◽  
Buqing Liang ◽  
Sacit B. Omay ◽  
Sathwik R. Shetty ◽  
...  
Keyword(s):  
Systematic Review ◽  
Growth Hormone ◽  
Disease Control ◽  
Cavernous Sinus ◽  
Tumor Size ◽  
Hormonal Control ◽  
Cavernous Sinus Invasion ◽  
Surgery Group ◽  
The Mean ◽  
First Time

OBJECTIVESurgery is generally the first-line therapy for acromegaly. For patients with residual or recurrent tumors, several treatment options exist, including repeat surgery, medical therapy, and radiation. Reoperation for recurrent acromegaly has been associated with poor results, with hormonal control usually achieved in fewer than 50% of cases. Extended endonasal endoscopic approaches (EEAs) may potentially improve the results of reoperation for acromegaly by providing increased visibility and maneuverability in parasellar areas.METHODSA database of all patients treated in the authors’ center between July 2004 and February 2016 was reviewed. Cases involving patients with acromegaly secondary to growth hormone (GH)–secreting adenomas who underwent EEA were selected for chart review and divided into 2 groups: first-time surgery and reoperation. Disease control was defined by 2010 guidelines. Clinical and radiological characteristics and outcome data were extracted. A systematic review was done through a MEDLINE database search (2000–2016) to identify studies on the surgical treatment of acromegaly. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the included studies were reviewed for surgical approach, tumor size, cavernous sinus invasion, disease control, and complications. Cases were divided into reoperation or first-time surgery for comparative analysis.RESULTSA total of 44 patients from the authors’ institution were included in this study. Of these patients, 2 underwent both first-time surgery and reoperation during the study period and were therefore included in both groups. Thus data from 46 surgical cases were analyzed (35 first-time operations and 11 reoperations). The mean length of follow-up was 70 months (range 6–150 months). The mean size of the reoperated tumors was 14.8 ± 10.0 mm (5 micro- and 6 macroadenomas). The patients’ mean age at the time of surgery was younger in the reoperation group than in the first-time surgery group (34.3 ± 12.8 years vs 49.1 ± 15.7 years, p = 0.007) and the mean preoperative GH level was also lower (7.7 ± 13.1 μg/L vs 25.6 ± 36.8 μg/L, p = 0.04). There was no statistically significant difference in disease control rates between the reoperation (7 [63.6%] of 11) and first-time surgery (25 [71.4%] of 33) groups (p = 0.71). Univariate analysis showed that older age, smaller tumor size, lower preoperative GH level, lower preoperative IGF-I level, and absence of cavernous sinus invasion were associated with higher chances of disease control in the first-time surgery group, whereas only absence of cavernous sinus invasion was associated with disease control in the reoperation group (p = 0.01). There was 1 case (9%) of transient diabetes insipidus and hypogonadism and 1 (9%) postoperative nasal infection after reoperation. The systematic review retrieved 29 papers with 161 reoperation and 2189 first-time surgery cases. Overall disease control for reoperation was 46.8% (95% CI 20%–74%) versus 56.4% (95% CI 49%–63%) for first-time operation. Reoperation and first-time surgery had similar control rates for microadenomas (73.6% [95% CI 32%–98%] vs 77.6% [95% CI 68%–85%]); however, reoperation was associated with substantially lower control rates for macroadenomas (27.5% [95% CI 5%–57%] vs 54.3% [95% CI 45%–62%]) and tumors invading the cavernous sinus (14.7% [95% CI 4%–29%] vs 38.5% [95% CI 27%–50%]).CONCLUSIONSReoperative EEA for acromegaly had results similar to those for first-time surgery and rates of control for macroadenomas that were better than historical rates. Cavernous sinus invasion continues to be a negative prognostic indicator for disease control; however, results with EEA show improvement compared with results reported in the prior literature.

Early radiation response between GnRH agonist versus antagonist combined with radiotherapy in high-risk prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 97-97 ◽  
Author(s):  
Gilles Crehange ◽  
Alexandre Cochet ◽  
Adele Cueff ◽  
Etienne Martin ◽  
Philippe Maingon ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Gnrh Agonist ◽  
Peripheral Zone ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Central Gland ◽  
The Mean ◽  
Early Radiation ◽  
Pathway Inhibition

97 Background: Degarelix, a GnRH antagonist, provides a very rapid and sustained testosterone suppression alongside with the VEGF pathway inhibition through the FSH receptors. This raises the question as to whether high risk localized prostate cancer (HRPCa) could respond differently to radiotherapy (RT) + Degarelix when compared with RT + GnRH agonist. Methods: 30 HRPCa patients were treated with exclusive RT combined with a GnRH agonist (n= 19) or Degarelix (n= 11). MRSI was performed before the start of hormones and 3 months after the end of RT. Choline (tumor metabolism) and citrate (healthy prostate metabolism) were quantified with MR spectroscopy and the slopes of gadolinium wash-in (SWI) and wash-out (SWO) were assessed in the peripheral zone (PZ), the central gland (CG) and the tumor with DCE-MRI. Results: At baseline, 14 patients had a T3 (46.7%) and 9 patients (30%) had a GS≥8. The median PSA values were 12.7 ng/mL [3.0-153.7] for agonists and 14.0 ng/mL [6.8-23.6] for Degarelix (p=ns). The mean prostate volumes (Pvol) were 32.0±15.5 mL for agonist and 33.0±10.0 mL for Degarelix (p=ns). The median dose of RT was 78Gy in each group, [72.0-80.0] with agonist and [70.2-80.0] with Degarelix. There were no significant differences in choline, citrate, SWI and SWO in the PZ, the CG and the tumor. At 3 months, Pvol were 20.8±8.0 mL for agonist and 21.4±6.2 mL for Degarelix (p=0.71) and the mean and median PSA values for agonist vs Degarelix were 0.5±0.8 ng/mL vs 0.1±0.1 ng/mL and 0.1 ng/mL [0.02-2.8] vs 0.1 ng/mL [0.005-0.3], respectively. Citrate was significantly decreased with Degarelix in the PZ (4.3±4.4 vs 1.1±0.8, p=0.0142), in the CG (4.0±4.0 vs 1.1±1.0, p=0.009) but not in the tumor (2.5±2.6 vs 1.7±1.9, p=0.23). Choline concentrations were similar between both groups in the PZ, the CG and the tumor. There was a trend towards a lower contrast uptake in the tumor with Degarelix (mean SWI and SWO: 134.6±56.2 s-1 vs 104.1±36.3 s-1, p=0.13 and 259.6±103.1 s-1 vs 306.1±70.4 s-1, p=0.15). Conclusions: Degarelix combined with RT offers a significant early, more profound metabolic atrophy in the prostate, but not in the tumor. There is a trend towards a lower tumor vascularization with Degarelix compared with GnRH agonists.

scholarly journals Pituitary adenoma apoplexy

2017 ◽  
Vol 95 (2) ◽  
pp. 177-180
Author(s):  
Irina V. Tereshchenko
Keyword(s):  
Risk Factors ◽  
Pituitary Adenoma ◽  
Young Women ◽  
Pituitary Apoplexy ◽  
Clinical Presentation ◽  
Diagnostic Errors

We present 3 cases of pituitary adenoma apoplexy in young women (one microadenoma and two macroadenomas). The possible risk factors, clinical presentation and outcome of pituitary apoplexy are discussed. Diagnostic errors as regards pituitary adenoma apoplexy are analyzed.

scholarly journals Vasospasm Post Pituitary Surgery: Systematic Review and 3 Case Presentations

2012 ◽  
Vol 39 (6) ◽  
pp. 767-773 ◽  
Author(s):  
Alireza Mansouri ◽  
Aria Fallah ◽  
Michael D. Cusimano ◽  
Sunit Das
Keyword(s):  
Systematic Review ◽  
Subarachnoid Hemorrhage ◽  
Pituitary Adenoma ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Pituitary Surgery ◽  
Neurological Status ◽  
Postoperative Hemorrhage ◽  
Clinical Appearance ◽  
Postoperative Hematoma

Background:Vasospasm is a known complication of aneurysmal subarachnoid hemorrhage and is a major cause of neurological morbidity and mortality. It is infrequently associated with pituitary adenoma surgery. We report three cases and present a systematic review of the literature with a view towards guiding neurosurgeons in the prevention and management of this complication.Results:Including our experience, vasospasm complicating pituitary adenoma surgery has been documented in 29 patients (mean age of 45). All cases occurred in the setting of a postoperative hemorrhage: 21 had a subarachnoid hemorrhage and 10 had a postoperative hematoma requiring evacuation. Initial clinical appearance of delayed cerebral ischemia attributable to vasospasm occurred from postoperative Days 2-13 (most commonly Day 5). Digital subtraction angiography and medical management were the most common diagnostic and therapeutic strategies, respectively. Glasgow Outcome Scores were ≤3 in 59% of cases. Univariate logistic regression identified later diagnosis of vasospasm and surgery for hematoma evacuation to be independently associated with better outcomes.Conclusion:Vasospasm should be considered in the differential diagnosis of patients demonstrating altered mental or neurological status following pituitary surgery, particularly if there has been postoperative hemorrhage of any degree. Prompt treatment should be instituted to optimize outcome.

Pituitary Apoplexy: A Rare Cause of Cerebral Infarction

2008 ◽  
Vol 21 (5) ◽  
pp. 661-665 ◽  
Author(s):  
A. Ben-Nakhi ◽  
T.J.E. Muttikkal ◽  
V.N.K. Chavan ◽  
A. Yt Al-Turkomani ◽  
R. Gupta
Keyword(s):  
Pituitary Adenoma ◽  
Cerebral Ischemia ◽  
Sudden Death ◽  
Cerebral Infarction ◽  
Pituitary Apoplexy ◽  
Clinical Presentation ◽  
Mass Effect ◽  
Mechanical Obstruction ◽  
Hemorrhagic Infarction

Pituitary apoplexy is usually the result of hemorrhagic infarction in pituitary adenoma. The clinical presentation of pituitary apoplexy varies widely and includes asymptomatic hemorrhage, classical pituitary apoplexy and even sudden death. Few cases of cerebral infarction associated with pituitary apoplexy have been reported in the literature. Pituitary apoplexy can cause narrowing of intracranial vessels by mechanical obstruction due to mass effect or by vasospasm resulting in cerebral ischemia. We report a case of pituitary apoplexy associated with cerebral infarction and the putative mechanisms.

scholarly journals Pituitary apoplexy induced by gonadotropin-releasing hormone agonist administration: a rare complication of prostate cancer treatment

2020 ◽  
Vol 2020 ◽  
Author(s):  
Mariana Barbosa ◽  
Sílvia Paredes ◽  
Maria João Machado ◽  
Rui Almeida ◽  
Olinda Marques
Keyword(s):  
Prostate Cancer ◽  
Gnrh Agonist ◽  
Advanced Prostate Cancer ◽  
Healthcare Professionals ◽  
Pituitary Apoplexy ◽  
Gonadotropin Releasing Hormone ◽  
List Type ◽  
Releasing Hormone ◽  
Gonadotropin Releasing Hormone Agonist ◽  
Life Threatening

Summary Gonadotropin-releasing hormone (GnRH) agonists, currently used in the treatment of advanced prostate cancer, have been described as a rare cause of pituitary apoplexy, a potentially life-threatening clinical condition. We report the case of a 69-year-old man with a known pituitary macroadenoma who was diagnosed with prostate cancer and started treatment with GnRH agonist leuprorelin (other hormones were not tested before treatment). Few minutes after drug administration, the patient presented with acute-onset severe headache, followed by left eye ptosis, diplopia and vomiting. Pituitary MRI revealed tumor enlargement and T1-hyperintense signal, compatible with recent bleeding sellar content. Laboratory endocrine workup was significant for low total testosterone. The patient was managed conservatively with high-dose steroids, and symptoms significantly improved. This case describes a rare phenomenon, pituitary apoplexy induced by GnRH agonist. We review the literature regarding this condition: the pathophysiological mechanism involved is not clearly established and several hypotheses have been proposed. Although uncommon, healthcare professionals and patients should be aware of this complication and recognize the signs, preventing a delay in diagnosis and treatment. Learning points: Pituitary apoplexy (PA) is a potentially life-threatening complication that can be caused by gonadotropin-releasing hormone agonist (GnRHa) administration for the treatment of advanced prostate cancer. This complication is rare but should be taken into account when using GnRHa, particularly in the setting of a known pre-existing pituitary adenoma. PA presents with classic clinical signs and symptoms that should be promptly recognized. Patients should be instructed to seek medical care if suspicious symptoms occur. Healthcare professionals should be aware of this complication, enabling its early recognition, adequate treatment and favorable outcome.

scholarly journals Outcome of Pituitary Adenoma Surgery Through Transphenoidal Microscopic Approach : A Study of 15 Cases

2015 ◽  
Vol 14 (2) ◽  
pp. 38-42
Author(s):  
Haradhan Deb Nath ◽  
Kanak Kanti Barua ◽  
Malay Kumar Das ◽  
Shahnewaz Bari
Keyword(s):  
Minimally Invasive Surgery ◽  
Pituitary Adenoma ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Pituitary Apoplexy ◽  
Pituitary Surgery ◽  
Visual Disturbance ◽  
Age Group ◽  
Microscopic Approach

Background: Transphenoidal microscopic approach is minimally invasive surgery in case of pituitary adenoma. Comparatively less complication than transcranial approach.Objective: The purpose of the study to see the outcome of transphenoidal microscopic removal of pituitary adenoma.Results: The study showed the majority 8(53.33%) of patients were female. It was documented that 7(46.66%) of patient had age group 21-40 years. It was evident that 13(86.66%) of patient had macroadenoma. Among the 15 patients 14(93.33%) had visual disturbance and 1(6.64%) had pituitary apoplexy. Tumor was totally removed under microscope in 10(66.67%) cases. It was documented that 12(80.11%) of patients improved after surgery.Conclusion: Transphenoidal microscopic pituitary surgery is one of the important procedure which can save many lives with lack of postoperative complication.Chatt Maa Shi Hosp Med Coll J; Vol.14 (2); Jul 2015; Page 38-42

Natural course of incidentally found nonfunctioning pituitary adenoma, with special reference to pituitary apoplexy during follow-up examination

2006 ◽  
Vol 104 (6) ◽  
pp. 884-891 ◽  
Author(s):  
Kazunori Arita ◽  
Atsushi Tominaga ◽  
Kazuhiko Sugiyama ◽  
Kuniki Eguchi ◽  
Koji Iida ◽  
...  
Keyword(s):  
Tumor Size ◽  
Pituitary Adenomas ◽  
Pituitary Apoplexy ◽  
Natural Course ◽  
Resonance Imaging ◽  
Imaging Studies ◽  
Initial Tumor ◽  
The Mean ◽  
Initial Tumor Size

Object The increase in the incidental detection of asymptomatic pituitary adenomas, known as “pituitary inciden-talomas,” led the authors to conduct a survey of the natural course of these lesions. Methods Forty-two patients with clinically nonfunctioning pituitary adenomas who had manifested no neurological or endocrinological disorders were monitored with magnetic resonance imaging studies. The follow-up period ranged from 10.8 to 168.2 months (mean ± standard deviation, 61.9 ± 38.2 months). The mean initial tumor size was 18.3 ± 7 mm. In 21 patients, the tumor increased by at least 10% of its measured size on detection. This increase was first detected between 8.4 and 58.8 months (mean 31.8 ± 17.6 months) after diagnosis. There was no correlation between the original tumor size, patient age, or the presence of intratumoral cysts and tumor growth. Symptoms were noted in 10 patients during follow up; in four, extensive tumor necrosis accompanied hemorrhage, leading to severe headache, acute ophthalmological symptoms, and panhypopituitarism, which was indicative of pituitary apoplexy. Transsphenoidal surgery was performed in 12 patients with enlarged tumors, including three with apoplexy. With the exception of one apoplectic patient, visual function was recovered in all who underwent surgery. All apoplectic patients continue to manifest hypopituitarism. Conclusions In the course of 4 years, the size of the incidentalomas increased in 40% of 42 patients and became symptomatic in 20%. During the 5-year follow up, pituitary apoplexy developed in 9.5%. These findings may justify early intervention, especially in young individuals with incidentally found macroadenoma.

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