Abstract
Disclosure: G.I. Sydney: None. P. balasubramanian: None.
Background: Pituitary apoplexy is a rare yet serious condition characterized by acute hemorrhage or infarction of the pituitary gland. Gonadotropin-releasing hormone (GnRH) agonists have been implicated as potential triggers for pituitary apoplexy, particularly in patients with known pituitary adenomas. Here, we report a case of a patient with no prior diagnosis of pituitary adenoma, who developed pituitary apoplexy in the context of GnRH agonist therapy for in vitro fertilization (IVF). Case Presentation: A 31-year-old female with a history of infertility and recurrent miscarriages presented with acute onset intractable headache, nausea and dizziness a few days after her initial round of IVF utilizing a micro-Lupron flare protocol for egg retrieval. Physical examination revealed intact visual field and a normal cranial nerve exam, with no focal neurological deficits. MRI pituitary demonstrated a 1.2 x 0.9 x 1 cm pituitary mass with a non-enhancing hemorrhagic focus with extension into the suprasellar cistern without significant mass effect on the optic chiasm. Biochemical evaluation was unremarkable with the exception of a mildly elevated prolactin of 51.3 ng/mlL (reference range : 3.0-30.0 ng/mlL), likely due to stalk effect. Given the patient’s clinical stability and lack of neurological deficits, a conservative management approach was pursued during the hospitalization, deferring surgical intervention to the outpatient setting. A decision for surgical intervention was based on her immediate plans for pregnancy and concern for mass effect on the optic chiasm due to physiological enlargement of the pituitary gland in pregnancy. Conclusion: Pituitary apoplexy, although rare, has been reported in association with GnRH agonist therapy, typically in patients with pre-existing gonadotropin-secreting or nonfunctioning pituitary adenomas. The latency between treatment and symptoms onset is variable. The proposed pathophysiologic mechanism involves pituitary stimulation by GnRH agonists, potentially leading to the underlying adenoma’s growth and subsequent tissue infraction or hemorrhage. This case underscores the risk of pituitary apoplexy in the setting of IVF-related GnRH agonist therapy and highlights the importance of early recognition and prompt management of this rare yet serious complication.
Presentation: Monday, July 14, 2025