SHM Converge Scientific Abstract ePoster Gallery-Leuprolide-Induced Apoplexy in the Absence of Pituitary Adenoma

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This case report describes a rare, fatal episode of pituitary apoplexy following a first leuprolide injection in an 86-year-old man with stage 2 prostate cancer. Shortly after treatment, he developed facial flushing, a sensation of eye bulging, dizziness, delirium, seizure activity, and severe hypertension. Although he had no known prior pituitary disease, CT and MRI revealed a 1.5 cm pituitary mass near the optic pathway with non-enhancement, suggesting apoplexy.  <br /><br />The patient’s condition rapidly worsened with high fever, confusion, and need for intubation. Empiric treatment for meningoencephalitis was started, but he suffered cardiac arrest and died. Autopsy demonstrated a 1.4 cm sellar mass with extensive hemorrhage, and microscopic findings confirmed hemorrhagic pituitary apoplexy as the cause of death.  <br /><br />The report explains that leuprolide, a gonadotropin-releasing hormone (GnRH) agonist, initially stimulates pituitary activity before downregulating hormone production. In patients with an occult pituitary adenoma, this surge may increase metabolic demand beyond the tumor’s blood supply, leading to ischemia, hemorrhage, and apoplexy.  <br /><br />The authors emphasize that pituitary apoplexy should be considered when patients receiving leuprolide develop headache, neurologic symptoms, altered mental status, or hemodynamic instability. They also recommend that clinicians consider screening for pituitary adenoma before starting GnRH agonists in selected patients, as this rare complication can be life-threatening.

Asset Subtitle

Azka Naeem

Meta Tag

Author List Aruge Lutaf, Azka Naeem, Kelash Kumar, Marlon Rivera Boadla, Mayukh Dey, Muhammad Hashim Khan

Category Clinical Vignettes

Concept Leuprolide

Concept Pituitary Apoplexy

Concept Gonadotropin-Releasing Hormone Agonist

Concept Pituitary Adenoma

Concept Pituitary Hormone Production

Distinguished Non-Finalist

Presenter Organization Maimonides Hospital

Presenting Author Azka Naeem

Track Adult

Keywords

pituitary apoplexy

leuprolide

GnRH agonist

prostate cancer

pituitary adenoma

hemorrhagic sellar mass

autopsy

seizure

hypertension

altered mental status

Leuprolide

Pituitary Apoplexy

Gonadotropin-Releasing Hormone Agonist

Pituitary Adenoma

Pituitary Hormone Production