Department of Endocrinology and Center for Translational Endocrinology (CETREN-UC), School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Pituitary Tumor Program. Red de Salud UC-CHRISTUS, Santiago, Chile.
Pituitary. 2021 Oct;24(5):681-689. doi: 10.1007/s11102-021-01143-6. Epub 2021 Apr 9.
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.
A retrospective chart review was performed on seven patients receiving GnRHa who developed PA. Prior reported cases were analyzed.
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.
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.
在一系列患者中检查促性腺激素释放激素激动剂（GnRHa）治疗后发生垂体卒中（PA）的临床表现和纵向结局，并与之前的报告进行比较。
对 7 例接受 GnRHa 治疗后发生 PA 的患者进行回顾性图表审查。分析了先前报告的病例。
6 例男性（中位年龄 72 岁）患有前列腺癌，1 例女性（22 岁）接受卵子捐赠，1990 年至 2020 年间发生 PA。大多数患者在第一剂后 24 小时内出现，但是有 2 例在 GnRHa 开始后 1 至 5 个月发生 PA。主要临床表现为头痛（100%）、恶心和呕吐（86%）。虽然没有患者有先前已知的垂体肿瘤，但所有患者的影像学检查均显示鞍区肿块和/或出血。在接受手术治疗的 5 例患者中（5/7），80%（4/5）的患者的病理标本对促性腺激素呈阳性染色；其余患者的病理标本为坏死。在发生 PA 时，最常见的垂体功能障碍是皮质醇不足。在部分患者中，中枢肾上腺功能不全和中枢性甲状腺功能减退是可逆的。垂体影像学保持稳定。
这是首次报告 GnRHa 给药后发生 PA 的病例系列，并进行了纵向随访。尽管很少见，但 PA 可能危及生命，应怀疑接受 GnRHa 治疗的患者，无论是否有已知的垂体腺瘤，在发生急性头痛、恶心和/或呕吐时。由于部分患者的垂体功能减退是可逆的，可能需要进行持续的垂体功能检测。
