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Pituitary tumor apoplexy is a rare clinical syndrome characterized by hemorrhagic infarction of a pre-existing adenoma followed by the acute onset of headache,vomiting,visual disturbances,and sometimes alteration in the level of consciousness.Although the pathophysiology of its development is not known,there are some apparent precipitating factors as recently summarized by Ebersold et al.A few recent reports described the occurrence of apoplexy after dynamic testing of anterior pituitary function.In all of these instances,the apoplectic episode occurred after the combined administration of thyrotropin-releasing hormone(TRH)and gonadotropin- releasing hormone(GnRH),insulin,or glucagon.Although GnRH is commonly used in the dynamic testing of pituitary gonadotropin secretion,there are,to our knowledge,no known serious neurologic complications associated with its use.Apoplexy has never been reported to occur after the single injection of this hypothalamic-releasing factor.In this report,we describe a patient with hyperprolactinemia in association with a pituitary macroadenoma who developed hemorrhagic infarction of the adenoma following the intravenous administration of GnRH.The patient had an uneventful recovery after transsphenoidal removal of the necrotic tumor. |
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