GnRH agonist-associated pituitary apoplexy: a case series and review of the literature.
GnRH agonist-associated pituitary apoplexy: a case series and review of the literature.
复制标题
GnRH 激动剂相关垂体卒中：病例系列和文献综述。
DOI：
10.1007/s11102-021-01143-6
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发表时间：
2021
期刊：
影响因子：
3.8
通讯作者：
Nachtigall,LisaB
中科院分区：
文献类型：
--
作者：
Guarda,FranciscoJ;Yu,Xiaoling;Shiraliyeva,Naila;Haines,MelanieS;Bradbury,Michael;Saylor,PhilipJ;Nachtigall,LisaB
PurposeTo研究的临床表现和纵向结果PAPODIUM（PA）后，促性腺激素释放激素激动剂（GnRHa）在一系列patients和比较到以前的reports.MethodsA回顾性图表审查进行了7例GnRHa谁开发PA。先前报道的情况下进行了analysed.Results6名男性（中位年龄72岁）与前列腺癌和一名女性（年龄22岁）进行卵子捐赠与PA在1990年和2020年之间。大多数在首次给药后24小时内出现，但2例在GnRHa开始后1至5个月出现PA。主要临床表现为头痛（100%），恶心、呕吐（86%）。虽然没有患者先前已知有垂体瘤，但所有患者的影像学均显示鞍区肿块和/或出血。在手术治疗的患者中（5/7），80%（4/5）的患者的病理标本促性腺激素染色阳性;其余患者的病理标本坏死。在PA时，最常见的垂体功能障碍是皮质醇减少症。中枢性肾上腺功能不全和中枢性甲状腺功能减退症在一个亚组中是可逆的。PGEX成像保持stabilized.ConclusionsThis是第一次报告的病例系列PA后，GnRHa管理与纵向随访。虽然不常见，但PA可能危及生命，在接受GnRHa治疗的患者中，无论是否患有已知的垂体腺瘤，如果发生急性头痛、恶心和/或呕吐，都应怀疑PA。由于垂体功能减退症在一个子集中是可逆的，因此可能需要进行垂体功能检查。
PurposeTo 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.MethodsA retrospective chart review was performed on seven patients receiving GnRHa who developed PA. Prior reported cases were analyzed.ResultsSix 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.ConclusionsThis 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.