Pituitary apoplexy following gonadotropin-releasing hormone agonist administration with gonadotropin-secreting pituitary adenoma.
Pituitary apoplexy following gonadotropin-releasing hormone agonist administration with gonadotropin-secreting pituitary adenoma.
复制标题
促性腺激素释放激素激动剂与促性腺激素分泌性垂体腺瘤一起给药后发生垂体卒中。
DOI：
10.1016/j.jocn.2014.08.015
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发表时间：
2015
期刊：
影响因子：
2
通讯作者：
Iizuka H.
中科院分区：
文献类型：
--
作者：
Sasagawa Y;Tachibana O;Nakagawa A;Koya D;Iizuka H.
促性腺激素释放激素(GnRH)激动剂广泛应用于前列腺癌的激素治疗。我们报告一位接受此疗法治疗的垂体卒中患者，这是一种罕见的并发症，并回顾了相关文献。一名62岁男性患者出现前列腺特异性抗原升高。经直肠超声引导下前列腺活检发现前列腺癌。全身18F-脱氧葡萄糖(FDG)正电子发射断层扫描/CT扫描显示脑垂体区摄取FDG。MRI还显示为脑垂体瘤，诊断为偶发的无功能腺瘤。患者接受了他的第一剂促性腺激素释放激素激动剂(亮丙瑞林11.25毫克)抗前列腺癌。他在服用亮丙瑞林10分钟后抱怨严重头痛，并在接下来的48小时内患上了右侧第三神经麻痹。MRI在T1加权像上显示高信号区，诊断为垂体卒中。患者接受了经蝶窦手术。病理显示主要是坏死组织和一个分泌促性腺激素的垂体腺瘤。总体而言，包括我们在内的15名患者在GnRH激动剂出现病理性促性腺激素分泌腺瘤后发生了垂体卒中。15例患者中有14例为男性。15例患者中有8例在用药后4小时内发生了垂体卒中。综合数据表明，促性腺激素释放激素激动剂有可能诱发男性促性腺激素分泌腺瘤患者的垂体卒中。因此，在前列腺癌的促性腺激素释放激素激动剂治疗之前，应先治疗已知的垂体腺瘤。否则，应仔细观察患者在服药后是否有任何症状变化。
Gonadotropin-releasing hormone (GnRH) agonists are widely used in hormone therapy for prostate cancer. We report a patient with pituitary apoplexy following this therapy as a rare complication and review the related literature. A 62-year-old man presented with elevated prostate specific antigen. Transrectal ultrasound guided biopsy of the prostate gland revealed adenocarcinoma. Whole-body18F-fluorodeoxyglucose (FDG) positron emission tomography/CT scan showed FDG-uptake in the pituitary region. MRI also demonstrated a pituitary tumor, diagnosed as an incidental non-functioning adenoma. The patient received his first dose of GnRH agonist (leuprolide 11.25 mg) against prostate cancer. He complained of a severe headache 10 minutes after leuprolide administration and suffered from right third nerve palsy in the next 48 hours. MRI demonstrated a high intensity area on T1-weighted images, diagnosed as pituitary apoplexy. The patient underwent transsphenoidal surgery. Pathology revealed predominantly necrotic tissue and a gonadotropin secreting pituitary adenoma. Overall, 15 patients, including ours, have been reported with pituitary apoplexy after GnRH agonists with pathologic gonadotropin secreting adenoma. Fourteen of 15 patients were male. Pituitary apoplexy developed within 4 hours after administration of the agents in 8/15 patients. The combined data suggest that GnRH agonists have the potential to precipitate pituitary apoplexy in men with gonadotropin secreting adenoma. Therefore, prior to GnRH agonist therapy for prostate cancer, a known pituitary adenoma should be treated. Otherwise, the patients should be cautiously observed for any symptomatic change following drug administration.