A Case of Pituitary Apoplexy Following Leuprolide Injection for Prostate Cancer

Area of Science:

• Endocrinology
• Oncology
• Neurology

Background:

• Androgen deprivation therapy (ADT) using gonadotropin-releasing hormone (GnRH) agonists is a standard treatment for advanced prostate cancer.
• While effective, ADT can rarely lead to serious complications.
• Pituitary apoplexy, a sudden hemorrhage or infarction of the pituitary gland, is a critical but infrequent adverse event associated with this therapy.

Observation:

• A 70-year-old male with prostate cancer developed pituitary apoplexy after initiating leuprolide acetate, a GnRH agonist.
• Symptoms included hot flashes, nausea, vomiting, and cranial nerve III palsy.
• Imaging confirmed a pituitary adenoma with hemorrhage.

Findings:

• The patient was managed conservatively with a multidisciplinary approach.
• Symptoms showed improvement with conservative management.
• This case underscores the potential for GnRH agonist-induced pituitary apoplexy.

Implications:

• Clinicians must maintain a high index of suspicion for pituitary apoplexy in patients on GnRH agonist therapy.
• Prompt investigation of new neuro-ophthalmic symptoms is essential.
• Timely diagnosis and treatment are vital to reduce morbidity in prostate cancer patients undergoing ADT.