Brain Tumor Res Treat.  2023 Apr;11(2):153-157. 10.14791/btrt.2023.0006.

Pituitary Apoplexy After Leuprolide Therapy in a Breast Cancer Patient: A Case Report

• Lee J
• Hwang SC
• Park ST

• KMID: 2542078
• DOI: http://doi.org/10.14791/btrt.2023.0006

Abstract

Pituitary apoplexy (PA) is a clinical syndrome resulting from sudden hemorrhage and/or infarction of the pituitary gland. Recent reports documented the development of PA secondary to treatment with gonadotropin-releasing hormone (GnRH) agonists for prostate cancer. A 52-year-old woman visited our emergency room with a severe headache, occurred 1 day prior. She underwent breast-conserving surgery for breast cancer 1 month prior. She was currently undergoing radiation and hormone therapy, consisting of leuprorelin. Brain contrast-enhanced MRI revealed a pituitary adenoma with internal hemorrhage in the sellar and suprasellar areas. Pachymeningeal enhancement was observed along the retroclival and bilateral frontal areas. The patient was diagnosed with PA and aseptic meningitis. The patient underwent total excision via transsphenoidal surgery 8 days after admission. The patient was pathologically diagnosed with a pituitary adenoma with necrosis. On immunochemical staining, the tumor was positive for follicle-stimulating hormone. The follow-up MRI revealed no evidence of residual tumor or an improved pachymeningeal enhancement. She is currently undergoing follow-up at the neurosurgery and endocrinology outpatient departments with no noted complications. In breast cancer patients receiving GnRH agonist therapy, PA may be rare complication.

Keyword

Pituitary apoplexy; Gonadotropin-releasing hormone; Breast neoplasms; Leuprolide; Contraindications

Figure

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  Fig. 1 Initial MRI (A: Coronal T2, B: coronal precontrast T1, C-F: coronal contrast-enhanced-T1, G: sagittal contrast-enhanced-T1). A and B: The lesion showing heterogeneous signal intensity on T2 and high signal intensity on T1 was noted in the sellar and suprasellar regions. C: The left lateral aspect of the lesion exhibited gadolinium enhancement. D: The pituitary stalk was deviated on the right side, and the optic chiasm bowed upwardly. E and F: The pachymeningeal enhancement is accompanied in the retroclival area and bilateral frontal convexities.

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  Fig. 2 Pituitary hormones analyzed by immunochemistry in pituitary adenoma. The pituitary adenoma cells showed positive immunostaining for follicle-stimulating hormone (A, ×200), but non-specific for luteinising hormone (B, ×200).

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  Fig. 3 Follow-up MRI, 3 months postoperatively. The previously noted pituitary adenoma in the sellar and suprasellar regions was removed (A and B), and pachymeningeal enhancement also improved (C and D).

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