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Late onset of pituitary apoplexy following gonadotropin-releasing hormone agonist for prostate cancer treatment
  1. Ghada Elshimy1,
  2. Rishi Raj2,3,
  3. Aasems Jacob4 and
  4. Ricardo Correa5
  1. 1Endocrinology, Augusta University Medical College of Georgia, Augusta, Georgia, USA
  2. 2Endocrinology, Diabetes and Metabolism, Pikeville Medical Center, Pikeville, Kentucky, USA
  3. 3Endocrinology, Diabetes and Metabolism, University of Pikeville Kentucky College of Osteopathic Medicine, Pikeville, Kentucky, USA
  4. 4Hematology and Oncology, Pikeville Medical Center, Pikeville, Kentucky, USA
  5. 5Endocrinology, Diabetes and Metabolism, The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
  1. Correspondence to Dr Rishi Raj; rishiraj91215{at}


Pituitary apoplexy (PA) is a clinical condition characterised by a sudden increase in pituitary gland volume secondary to ischaemia and/or necrosis. Most cases occur in non-functioning pituitary adenoma but can also occur in functioning adenoma. Certain predisposing factors can result in PA and the use of gonadotropin-releasing hormone (GnRH) agonists for prostate cancer (PCa) is one such condition. Once diagnosed, both surgical and conservative management has been used for the treatment of PA. We present a case of a man in his late 50s who developed PA following treatment of PCa with leuprolide. His symptoms developed insidiously and he presented 6 months after symptom onset. Anterior pituitary hormone workup along with pituitary MRI confirmed the diagnosis of PA and patient was subsequently treated with adequate replacement of pituitary hormone with significant improvement in his symptoms. It is very important to keep a high index of suspicion for PA, especially among elderly patients receiving GnRH agonist treatment for PCa.

  • endocrine system
  • malignant disease and immunosuppression
  • pituitary disorders
  • prostate cancer
  • unwanted effects / adverse reactions

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  • Twitter @DrRishi_Raj, @aJacobMD

  • Contributors GE, RR and AJ equally contributed in conceptualising, data acquisition, data interpretation, manuscript preparation and review of literature. RC provided with critical review and helped in revision of the final version of the manuscript. All the authors reviewed and approved the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.