Diagnosis and Treatment > Medication
Search for other papers by Mariana Barbosa in
Google Scholar
PubMed
Search for other papers by Sílvia Paredes in
Google Scholar
PubMed
Search for other papers by Maria João Machado in
Google Scholar
PubMed
Pituitary Consult, Hospital de Braga, Braga, Portugal
Search for other papers by Rui Almeida in
Google Scholar
PubMed
Pituitary Consult, Hospital de Braga, Braga, Portugal
Search for other papers by Olinda Marques in
Google Scholar
PubMed
Summary
Gonadotropin-releasing hormone (GnRH) agonists, currently used in the treatment of advanced prostate cancer, have been described as a rare cause of pituitary apoplexy, a potentially life-threatening clinical condition. We report the case of a 69-year-old man with a known pituitary macroadenoma who was diagnosed with prostate cancer and started treatment with GnRH agonist leuprorelin (other hormones were not tested before treatment). Few minutes after drug administration, the patient presented with acute-onset severe headache, followed by left eye ptosis, diplopia and vomiting. Pituitary MRI revealed tumor enlargement and T1-hyperintense signal, compatible with recent bleeding sellar content. Laboratory endocrine workup was significant for low total testosterone. The patient was managed conservatively with high-dose steroids, and symptoms significantly improved. This case describes a rare phenomenon, pituitary apoplexy induced by GnRH agonist. We review the literature regarding this condition: the pathophysiological mechanism involved is not clearly established and several hypotheses have been proposed. Although uncommon, healthcare professionals and patients should be aware of this complication and recognize the signs, preventing a delay in diagnosis and treatment.
Learning points:
-
Pituitary apoplexy (PA) is a potentially life-threatening complication that can be caused by gonadotropin-releasing hormone agonist (GnRHa) administration for the treatment of advanced prostate cancer.
-
This complication is rare but should be taken into account when using GnRHa, particularly in the setting of a known pre-existing pituitary adenoma.
-
PA presents with classic clinical signs and symptoms that should be promptly recognized.
-
Patients should be instructed to seek medical care if suspicious symptoms occur.
-
Healthcare professionals should be aware of this complication, enabling its early recognition, adequate treatment and favorable outcome.
Search for other papers by Leanne Hunt in
Google Scholar
PubMed
Search for other papers by Barney Harrison in
Google Scholar
PubMed
Search for other papers by Matthew Bull in
Google Scholar
PubMed
Search for other papers by Tim Stephenson in
Google Scholar
PubMed
Search for other papers by Amit Allahabadia in
Google Scholar
PubMed
Summary
This case report reviews the rare condition of Riedel’s thyroiditis via a patient case. The report highlights the difficulties that one may encounter when managing such a case in regards to patient symptoms, side effects of medications and the relapsing nature of the condition. The case report also highlights novel treatment in the treatment of Riedel’s thyroiditis, rituximab, how this works and the resolution of symptoms that we have achieved with our patient on this treatment.
Learning points:
-
Riedel’s thyroiditis is characterised by chronic inflammation, which causes dense fibrosis in the thyroid gland.
-
Riedel’s thyroiditis can present with neck pain, dysphagia and dyspnoea with a firm, non-tender mass found on examination.
-
Riedel’s thyroiditis is part of the IgG4-related systemic disorders.
-
Rituximab is a monoclonal antibody that works against the protein CD20.
