PMID- 31667176
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 2307-8960 (Print)
IS  - 2307-8960 (Electronic)
IS  - 2307-8960 (Linking)
VI  - 7
IP  - 20
DP  - 2019 Oct 26
TI  - Gonadotrophin-releasing hormone agonist-induced pituitary adenoma apoplexy and 
      casual finding of a parathyroid carcinoma: A case report and review of 
      literature.
PG  - 3259-3265
LID - 10.12998/wjcc.v7.i20.3259 [doi]
AB  - BACKGROUND: Pituitary apoplexy represents one of the most serious, life 
      threatening endocrine emergencies that requires immediate management. 
      Gonadotropin-releasing hormone agonist (GnRHa) can induce pituitary apoplexy in 
      those patients who have insidious pituitary adenoma coincidentally. CASE SUMMARY: 
      A 46-year-old woman, with a history of hypertension and menorrhagia was 
      transferred to our hospital from a secondary care hospital after complaints of 
      headache and vomiting, with loss of consciousness 5 min after an injection of 
      GnRHa. The drug was prescribed by her gynecologist due to the presence of uterine 
      myomas. The clinical neurological examination revealed right cranial nerve III 
      palsy, ptosis and movement limitation of the right eye. Our first clinical 
      consideration was a pituitary apoplexy. Blood hormonal analysis revealed mild 
      hyperprolactinemia and high follicle stimulating hormone level; PTH and calcium 
      was high with glomerular filtration rate mildly to moderately decrease. A 
      computed tomography scan, revealed an enlarged pituitary gland (3.5 cm) impinging 
      upon the optic chiasm with bone involvement of the sella. Following contrast 
      media administration, the lesion showed homogeneous enhancement with high-density 
      focus that suggests hemorrhagic infarction of the tumor. Transsphenoidal 
      endoscopic surgery was perfomed and adenomatous tissue was removed. 
      Immunohistochemistry was positive for luteinizing hormone (LH) and 
      follicular-stimulating hormone (FSH). A solid hypoechoic nodule (14 mm x 13 mm x 
      16 mm) was found in the caudal portion of the right thyroid lobe after a 
      parathyroid ultrasound. A genetic test of Multiple Endocrine Neoplasia type 1 
      (MEN1) was negative. A right lower parathyroidectomy was performed and the 
      pathologic study showed the presence of an encapsulated parathyroid carcinoma of 
      1.5 cm. A MEN type 4 genetic test was performed result was negative. CONCLUSION: 
      This case demonstrates an uncommon complication of GnRH agonist therapy in the 
      setting of a pituitary macroadenoma and the casual finding of parathyroid 
      carcinoma. It also highlights the importance of suspecting the presence of a 
      multiple endocrine neoplasia syndrome and to carry out relevant genetic studies.
CI  - (c)The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights 
      reserved.
FAU - Trivino, Vanessa
AU  - Trivino V
AD  - Department of Endocrinology, Complejo Hospitalario Universitario A Coruna, A 
      Coruna 15006, Spain.
FAU - Fidalgo, Olga
AU  - Fidalgo O
AD  - Department of Endocrinology, Complejo Hospitalario Universitario A Coruna, A 
      Coruna 15006, Spain.
FAU - Juane, Antia
AU  - Juane A
AD  - Department of Endocrinology, Complejo Hospitalario Universitario A Coruna, A 
      Coruna 15006, Spain.
FAU - Pombo, Jorge
AU  - Pombo J
AD  - Department of pathological anatomy, Complejo Hospitalario Universitario A Coruna, 
      A Coruna 15006, Spain.
FAU - Cordido, Fernando
AU  - Cordido F
AD  - Department of Endocrinology, Complejo Hospitalario Universitario A Coruna, A 
      Coruna 15006, Spain. fernando.cordido.carballido@sergas.es.
LA  - eng
PT  - Case Reports
PL  - United States
TA  - World J Clin Cases
JT  - World journal of clinical cases
JID - 101618806
PMC - PMC6819301
OTO - NOTNLM
OT  - Case report
OT  - MEN type 1
OT  - MEN type 4
OT  - Parathyroid carcinoma
OT  - Pituitary adenoma
OT  - Pituitary apoplexy
OT  - Primary hyperparathyroidism
COIS- Conflict-of-interest statement: The authors declare that they have no conflict of 
      interest.
EDAT- 2019/11/02 06:00
MHDA- 2019/11/02 06:01
PMCR- 2019/10/26
CRDT- 2019/11/01 06:00
PHST- 2019/04/06 00:00 [received]
PHST- 2019/09/24 00:00 [revised]
PHST- 2019/10/05 00:00 [accepted]
PHST- 2019/11/01 06:00 [entrez]
PHST- 2019/11/02 06:00 [pubmed]
PHST- 2019/11/02 06:01 [medline]
PHST- 2019/10/26 00:00 [pmc-release]
AID - 10.12998/wjcc.v7.i20.3259 [doi]
PST - ppublish
SO  - World J Clin Cases. 2019 Oct 26;7(20):3259-3265. doi: 10.12998/wjcc.v7.i20.3259.