Pseudotumour cerebri as a side effect of leuprorelin acetate

Boot JH, J H Boot
Irish journal of medical science · 1996 · doi:10.1007/BF02942809 · PMID:8867506
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Leuprorelin acetate treatment for endometriosis in a 35-year-old woman induced pseudotumor cerebri and transient vision loss, which fully resolved after discontinuation of the medication.

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This case report describes a 35-year-old woman who developed pseudotumor cerebri, characterized by unilateral papilledema and visual field defects, after five months of treatment with leuprorelin acetate. Following the discontinuation of the medication, the patient experienced high fever and gradual recovery of eyesight over six months, suggesting the drug induced increased cerebrospinal fluid pressure. The authors attribute the condition to the hormonal mechanism of leuprorelin and advise careful monitoring of eye parameters during therapy to prevent permanent vision loss. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Leuprorelin acetate is a synthetic nona-peptide analogue of the naturally occurring gonadotrophin releasing hormone LH-RH (hypothalamus), used in the treatment of sterility, endometriosis or prostatic cancer. In a 35 year old woman, treated with leuprorelin acetate, after 5 months treatment, the side-effects (hot flushes, sweating, sleeping disorders), appeared to be rather unbearable. Medication was ended. The endocrine reversion to the normal physiological balance was association with high fever (38.9 degrees C) during an 8 day period. Increasing scotomas resulted in a gradual loss of eyesight in one eye, associated with a normal visual acuity. Unilateral papilloedema was observed, indicating the possibility of tumor cerebri. Fluorescein angiography demonstrated an intense leakage of the right optic disc. No signs of retinal vascular malformations were seen. The eye pressure was normal. No signs of hemorrhages were observed. Visual field examination showed an enlarged blind spot with a few scotomas above the centre of fixation. CT scan of the brain was normal, the cerebrospinal fluid (CSF) was normal, indicated by IgG production. Six months after ending the leuprorelin acetate treatment, the eyesight was spontaneously 100% recovered. It is most likely that leuprorelin acetate is responsible for the emergence of pseudotumor cerebri. As described by Prof. Sidi et al(1), leuprorelin strongly induces increased liquor pressure, being the intermediate mechanism between hormonal treatment and an ante grade mechanical force, on the optic nervus. Because of the risk of permanent loss of eyesight, it is strongly advised to verify eye parameters conscientiously during leuprorelin treatment.
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Abstract

Leuprorelin acetate is a synthetic nona-peptide analogue of the naturally occurring gonadotrophin releasing hormone LH-RH (hypothalamus), used in the treatment of sterility, endometriosis or prostatic cancer. In a 35 year old woman, treated withleuprorelin acetate, after 5 months treatment, the side-effects (hot flushes, sweating, sleeping disorders), appeared to be rather unbearable. Medication was ended. The endocrine reversion to the normal physiological balance was association with high fever (38.9°C) during an 8 day period. Increasing scotomas resulted in a gradual loss of eyesight in one eye, associated with a normal visual acuity. Unilateral papilledema was observed, indicating the possibility oftumor cerebri. Fluorescein angiography demonstrated an intense leakage of the right optic disc. No signs of retinal vascular malformations were seen. The eye pressure was normal. No signs of hemorrhages were observed. Visual field examination showed an enlarged blind spot with a few scotomas above the centre of fixation. CT scan of the brain was normal, the cerebrospinal fluid (CSF) was normal, indicated by IgG production. Six months after ending the leuprorelin acetate treatment, the eyesight was spontaneously 100% recovered. It is most likely that leuprorelin acetate is responsible for the emergence ofpseudotumor cerebri. As described by Prof. Sidiet al (1), leuprorelin strongly induces increased liquor pressure, being the intermediate mechanism between hormonal treatment and an ante grade mechanical force, on the optic nervus. Because of the risk of permanent loss of eyesight, it is strongly advised to verify eye parameters conscientiously during leuprorelin treatment.

References

Sidi, Y. et al.Pseudotumour cerebri, associated with leuprorelin acetate. The Lancet, March 17th, 1990, p. 668. Crosignani, P. G. Leuprorelin acetate depot vs Danazol in the treatment of endometriosis: Results of an open multicentre trial. Clinical Therapeutics 1992; Vol 14: pp. 28–34. Gerhard, I. Treatment of endometriosis with leuprorelin acetate depot: A German Multicentre study. Clinical Therapeutics 1992; Vol 14: pp. 3–13. Rights and permissions About this article Cite this article Boot, J.H. Letter to the editor. I.J.M.S. 165, 60 (1996). https://doi.org/10.1007/BF02942809 Issue date: DOI: https://doi.org/10.1007/BF02942809

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Condition tags

endometriosis

MeSH descriptors

Antineoplastic Agents, Hormonal Leuprolide Pseudotumor Cerebri Adult Antineoplastic Agents, Hormonal Female Humans Leuprolide Pseudotumor Cerebri

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