Table 2.

Summary of reported cases of pituitary apoplexy induced by gonadotropin-releasing hormone agonists.

Year	Reference	Patient age	GnRH agonist, dose	Time of onset	Symptoms/signs	Pathological findings	Treatment
1995	(11)	83	Goserelin, 3.6 mg	9 days	Headache, nausea/vomiting, altered mentation, diplopia, fever and hyponatremia	–	Medical
1995	(12)	78	Triptorelin, 3.75 mg	a few min	Headache, postural dizziness and left partial ophthalmoplegia	–	Medical
1996	(13)	74	Leuprolide, 7.5 mg	15 min	Headache, nausea/vomiting, left ophthalmoplegia, altered mentation, generalized weakness and visual disturbances	Stain FSH +, LH +, GH +	Surgical
1997	(14)	62	Leuprorelin, 3.75 mg	4 days	Headache, left ophthalmoplegia and papilledema	Stain FSH +, LH +	Surgical
2001	(15)	67	Goserelin, 3.6 mg	4 h	Headache, nausea/vomiting, visual disturbances, altered mentation and hypertension	Stain FSH +, LH +	Surgical
2002	(4)	74	Leuprolide, -	–	Headache and nausea/vomiting	–	Medical
2003	(16)	69	Leuprolide, -	<4 h	Headache, visual disturbances and diabetes insipidus	Stain FSH +	Surgical
2006	(17)	68	Goserelin, 3.6 mg	4–6 h	Headache, nausea/vomiting, altered mentation, diplopia and right ptosis	–	Surgical
2006	(18)	61	Leuprolide, 30 mg	a few hours	Headache, nausea/vomiting, diplopia and ophthalmoplegia	Stain FSH +	Surgical
2006	(19)	70	Leuprolide, 11.25 mg	10 days	Visual disturbances, diplopia and right ptosis	Stain FSH +	Surgical
2007	(20)	60	Leuprolide, 22.5 mg	4 hs	Headache, nausea/vomiting, altered mentation, visual disturbances, left ophthalmoplegia and diplopia	Stain LH +	Surgical
2010	(5)	71	Goserelin, -	8 weeks	Headache, nausea/vomiting and visual disturbances	Stain FSH +, LH +	Surgical
2010	(10)	60	Leuprolide, -	a few hours	Headache, left ophthalmoplegia and visual disturbances	Stain LH +	Surgical
2011	(6)	78	Goserelin, 3.6 mg	9 days	Headache, left ophthalmoplegia and visual disturbances	Stain FSH +	Surgical
2013	(9)	77	Leuprorelin, 3.75 mg	a few hours	Headache, nausea/vomiting and left ophthalmoplegia	–	Surgical
2014	(7)	60	Leuprolide, -	a few hours	Headache, nausea/vomiting, diplopia and left ptosis	Stain LH +, TSH +	Surgical
2015	(21).	62	Leuprolide, 11.25 mg	10 min	Headache, nausea/vomiting and right ophthalmoplegia	Stain FSH +, LH +	Surgical
2015	(8)	77	Triptorelin, 22.5 mg	1 h	Headache, nausea/vomiting, diplopia and right ptosis	–	Surgical
2016	(22)	67	Triptorelin, -	14 days	Headache and right ptosis	Stain FSH +, LH +	Surgical
2016	(23)	63	Leuprolide, 11.25 mg	3 days	Headache, visual disturbances and altered mentation	–	Medical
2017	(3)	85	Leuprolide, 45 mg	4 h	Headache and nausea/vomiting	–	Medical

FSH, follicle-stimulating hormone; GH, growth hormone; LH, luteinizing hormone; TSH, thyroid-stimulating hormone.