Leuprolide Injection Causing Pituitary Apoplexy: A Case Report

Abstract

There is growing evidence to support occurrence of pituitary apoplexy following administration of gonadotropin releasing hormone (GnRH) agonists in patients with gonadotropin-secreting pituitary adenomas. We report a case of pituitary apoplexy after depot administration of the GnRH agonist leuprolide. The patient is a 78 year-old man with Gleeson 7, non-invasive prostate cancer who was treated with his first dose of leuprolide two days prior to presentation. He developed a severe headache four hours after leuprolide administration. Non-contrast Magnetic Resonance Imaging (MRI) brain showed a 1.2 cm T1 hyper intensity in the anterior pituitary, likely representing a hemorrhagic adenoma or cyst. 1 month later his repeat MRI of the brain showed resolution of the hemorrhage, as well as a 3 mm lesion within the pituitary thought to be a micro adenoma. What is unique in our case is the mild degree of symptoms manifested by intractable headaches with normal vision and cranial nerve examination, requiring no surgical intervention. There may be a correlation with the size of the adenoma and the severity of disease burden caused by the apoplexy.