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Kinaan M, Hamidi O, Yau H, Courtney KD, Eraslan A, Simon K. Congenital Adrenal Hyperplasia Causing Poor Response to Androgen Deprivation Therapy in Prostate Cancer. J Endocr Soc 2021; 5:bvaa158. [PMID: 33294761 PMCID: PMC7692538 DOI: 10.1210/jendso/bvaa158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Indexed: 11/29/2022] Open
Abstract
Androgen deprivation therapy (ADT) is recommended for the treatment of advanced prostate cancer. Inadequate suppression of testosterone while on ADT poses a clinical challenge and requires evaluation of multiple potential causes, including adrenal virilizing disorders. We present 2 cases of elderly patients with prostate cancer who had undiagnosed congenital adrenal hyperplasia (CAH) driving persistent testosterone elevation during ADT. The first patient is a 73-year-old man who underwent radical prostatectomy on initial diagnosis and was later started on ADT with leuprolide following tumor recurrence. He had a testosterone level of 294.4 ng/dL and prostate-specific antigen (PSA) level of 17.7 ng/mL despite leuprolide use. Additional workup revealed adrenal nodular hyperplasia, elevated 17-hydroxyprogesterone (19 910 ng/dL) and dehydroepiandrosterone sulfate (378 mcg/dL), and 2 mutations of the CYP21A2 gene consistent with simple virilizing CAH. The second patient is an 82-year-old man who received stereotactic radiation therapy at time of diagnosis. He had insufficient suppression of testosterone with evidence of metastatic disease despite treatment with leuprolide and subsequently degarelix. Laboratory workup revealed elevated 17-hydroxyprogesterone (4910 ng/dL) and dehydroepiandrosterone sulfate (312 mcg/dL). Based on clinical, radiographic and biochemical findings, the patient was diagnosed with nonclassic CAH. The first patient initiated glucocorticoid therapy, and the second patient was treated with the CYP17 inhibitor abiraterone in combination with glucocorticoids. Both patients experienced rapid decline in testosterone and PSA levels. Inadequate testosterone suppression during ADT should trigger evaluation for causes of persistent hyperandrogenemia. CAH can lead to hyperandrogenemia and pose challenges when treating patients with prostate cancer.
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Affiliation(s)
- Mustafa Kinaan
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida.,Orlando VA Medical Center, Division of Endocrinology, Orlando, Florida
| | - Oksana Hamidi
- Division of Endocrinology and Metabolism, UT Southwestern Medical Center, Dallas, Texas
| | - Hanford Yau
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida.,Orlando VA Medical Center, Division of Endocrinology, Orlando, Florida
| | - Kevin D Courtney
- Simmons Comprehensive Cancer Center, Department of Internal Medicine, Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Akin Eraslan
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida.,Orlando VA Medical Center, Division of Endocrinology, Orlando, Florida
| | - Kenneth Simon
- Orlando VA Medical Center, Division of Oncology, Orlando, Florida
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[LOCAL REACTIONS OF LUTEINIZING HORMONE-RELEASING HORMONE AGENTS AND ITS EFFECTS ON CLINICAL OUTCOMES IN PROSTATE CANCER PATIENTS]. Nihon Hinyokika Gakkai Zasshi 2020; 111:120-129. [PMID: 34670910 DOI: 10.5980/jpnjurol.111.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
(Background) Currently, luteinizing hormone-releasing hormone (LH-RH) agonists and antagonists are used for androgen-deprivation therapy (ADT). However, they are associated with subcutaneous granuloma, rubor, dolor, calor, and eventual ulcer and/or abscess formation. The prevalence of these adverse effects, causes and mechanisms, and effects on serum testosterone levels and clinical outcomes are poorly understood. (Method) We collected the clinical records of men with pathologically diagnosed prostate cancer who were followed in our hospital. The primary aim of the study was to determine the prevalence of granuloma formation, its causes, and the mechanisms involved. The secondary aim was to analyze the effects of subcutaneous induration on serum testosterone levels and clinical outcomes. (Results) Overall, 185 men using leuprorelin (n=161; median age, 75 years), degarelix (n=21; median age, 76), or goserelin (n=3; median age, 76) were analyzed. In the leuprorelin cohort, 51 patients (33.5%) had subjective and/or objective subcutaneous induration and 2 (1.2%) had a large lesion (diameter > 3.0 cm). In the degarelix cohort, 18 patients (85.7%) developed induration and 8 (38%) had a large lesion. One month after the start of ADT, patients in the leuprorelin and degarelix cohorts had median serum testosterone levels that reached the same level as that after castration. There was no significant difference in the overall survival rate between the leuprorelin and degarelix cohorts. There was no significant difference in the serum testosterone level or overall survival rate between patients with or without induration. (Conclusions) The local adverse effects of LH-RH agents are prevalent, but we can regulate the adverse effects by understanding the mechanism involved. The formation of subcutaneous induration did not affect the serum testosterone level or clinical outcome.
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Chicharro P, Paniagua A, Rodríguez-Jiménez P, Ibañes S, Cortina B, Riveiro J, Sampedro-Núñez MÁ, Fraga J, Marazuela M, Daudén E. Diagnostic approach to subcutaneous nodules in patients with neuroendocrine tumours treated with depot somatostatin analogs: a cross-sectional study. J Eur Acad Dermatol Venereol 2018; 32:1887-1892. [PMID: 29377286 DOI: 10.1111/jdv.14830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/03/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The presence of cutaneous nodules in patients with gastroenteropancreatic neuroendocrine tumours (GEP-NETs) receiving depot somatostatin analogs (SSAs) is a diagnostic challenge as differential diagnosis between injection site reactions and metastases is essential. OBJECTIVE To characterize the clinical, radiological, cytological and histopathological features of subcutaneous nodules in patients with GEP-NETs treated with SSAs. MATERIALS AND METHODS Retrospective, cross-sectional study of patients with GEP-NETs treated with SSAs in whom subcutaneous nodules were detected on routine abdominal computed tomography (CT) scans. High resolution and colour Doppler ultrasonography was performed. Those patients with inconclusive radiological studies went through fine-needle aspiration cytology (FNAC) and/or biopsy. RESULTS Twelve patients (five males, seven females) were included (six midgut carcinoid NETs, six pancreatic NETs). Three patients received intramuscular depot octreotide, seven subcutaneous lanreotide, and two both treatments. CT scan findings were nonspecific. Sonography revealed a hyperechoic pattern in recent injections, and a hypoechoic pattern with a characteristic hyperechoic peripheral rim in long-term injections (more than 3 months after injection). On colour Doppler sonography, nodules showed no signs of intralesional vascularity. Fine-needle aspiration cytology (FNAC) was performed in five patients, revealing a characteristic acellular proteinaceous material. Biopsy in four patients showed different reactional infiltrates around the acellular material. CONCLUSIONS High resolution and colour Doppler ultrasonography may be very useful for the differential diagnosis of subcutaneous nodules in patients with GEP-NETs treated with SSAs. FNAC and a biopsy are useful tests for confirmation of the diagnosis in patients with inconclusive findings. We propose a management algorithm.
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Affiliation(s)
- P Chicharro
- Department of Dermatology, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - A Paniagua
- Department of Endocrinology, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - P Rodríguez-Jiménez
- Department of Dermatology, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - S Ibañes
- Department of Dermatology, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - B Cortina
- Department of Radiology, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - J Riveiro
- Department of Endocrinology, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - M Á Sampedro-Núñez
- Department of Endocrinology, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - J Fraga
- Department of Pathology, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - M Marazuela
- Department of Endocrinology, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - E Daudén
- Department of Dermatology, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
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[Fixed drug eruption induced by leuprorelin]. Ann Dermatol Venereol 2015; 142:780-1. [PMID: 26249532 DOI: 10.1016/j.annder.2015.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 03/30/2015] [Accepted: 06/15/2015] [Indexed: 11/21/2022]
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Foreign Body Granulomas Induced by Intramuscular Leuprorelin Acetate Injection for Prostate Cancer: Clinical Mimics of Soft Tissue Sarcoma. Case Rep Oncol Med 2015; 2015:947040. [PMID: 25918659 PMCID: PMC4397027 DOI: 10.1155/2015/947040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/20/2015] [Indexed: 11/18/2022] Open
Abstract
We describe two cases of florid, foreign body granulomatous reaction occurring in the upper arms of males in their eighth decade, who were undergoing treatment with depot injection of leuprorelin acetate for prostatic carcinoma. These patients presented with rapidly enlarging extremity soft tissue masses and were referred to a tertiary sarcoma center with clinical suspicion of a primary soft tissue neoplasm. The occurrence of injection site granulomas secondary to leuprorelin acetate administration is rarely known outside the urological and dermatological communities, and their recognition is important due to the spectrum of clinical differential diagnoses and potential for diagnostic confusion with metastatic prostatic cancer and primary sarcoma and in order to avoid unnecessary stress and clinical intervention for patients.
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Imaging of recurrent intramuscular granulomatous masses induced by depot injection of leuprorelin. Skeletal Radiol 2012; 41:347-52. [PMID: 21861209 DOI: 10.1007/s00256-011-1254-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 08/01/2011] [Accepted: 08/05/2011] [Indexed: 02/02/2023]
Abstract
Leuprorelin is a luteinizing hormone-releasing hormone (LH-RH) agonist that is used as an agent of androgen deprivation in some patients with prostate cancer. When administered in depot form, local granulomatous reactions may occur at the injection site, which may mimic masses and which are associated with treatment failure. We present a patient who, over a period of 5 years, developed multiple intramuscular gluteal masses while receiving leuprorelin therapy via intramuscular depot injections; biopsy of one of the masses showed the specific histologic features of leuprorelin granuloma. To our knowledge, this entity has not been described in the radiology literature. Awareness of this entity is necessary to suggest the correct diagnosis in patients with a history of leuprorelin depot injections.
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Ruiz-Hornillos J, HenrÃquez-Santana A, Moreno-Fernández A, González IG, Sánchez SR. Systemic allergic dermatitis caused by the solvent of Eligard®. Contact Dermatitis 2009; 61:355-6. [DOI: 10.1111/j.1600-0536.2009.01643.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Watanabe T, Yamada N, Yoshida Y, Yamamoto O. A morphological study of granulomas induced by subcutaneous injection of leuprorelin acetate. J Cutan Pathol 2009; 36:1299-302. [DOI: 10.1111/j.1600-0560.2009.01270.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bilateral injection-site granuloma by subcutaneous administration of luteinizing hormone-releasing hormone analogue: a case report. CASES JOURNAL 2009; 2:8326. [PMID: 19918419 PMCID: PMC2769429 DOI: 10.4076/1757-1626-2-8326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 08/19/2009] [Indexed: 11/17/2022]
Abstract
We report a typical case of injection-site granuloma attributed to subcutaneous administration of leuprorelin acetate, an LHRH agonist. A 70-year-old man who had undergone total prostatectomy and was subsequently given leuprorelin injections for prostatic cancer presented with bilateral nodules in the lower abdominal wall. An excisional biopsy revealed a non-caseous epithelioid granuloma consisting of CD-68 positive histiocytic cells with infiltration of T-lymphocytes and eosinophils; skin metastasis from prostatic adenocarcinoma was ruled out through histological and immunohistochemical analysis. Generally, granulomas may be caused by delayed-type hypersensitivity to the constituents of leuprorelin acetate injections.
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Pentinga SE, Bruining HG, Gerritsen WR, van den Eertwegh AJM, Rustemeyer T. A case of delayed-type hypersensitivity to subcutaneously administered drugs during anticancer immunotherapy. Br J Dermatol 2009; 160:1132-4. [PMID: 19292712 DOI: 10.1111/j.1365-2133.2009.09087.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abouelfadel Z, Crawford ED. Leuprorelin depot injection: patient considerations in the management of prostatic cancer. Ther Clin Risk Manag 2008; 4:513-26. [PMID: 18728847 PMCID: PMC2504071 DOI: 10.2147/tcrm.s6863] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hormone therapy is well established for treating patients with prostate cancer and remains the mainstay of the treatment of metastatic and locally advanced disease, this article reviews the rationale for its use, its different forms, and complications and controversies still surrounding some of its modalities. Availability of long-acting synthetic luteinizing hormone-releasing hormone (LHRH) agonists revolutionized the hormonal treatment of prostate cancer, and helped to avoid the emotional and psychological effects related to surgical castration. The depot formula has gained wide acceptance from both patients and physicians. This review emphasizes the newer, long-acting formula, leuprorelin (leuprolide acetate), especially the 6-month formula, its advantage over over shorter-acting depot products, and its potential to become a standard of care for patients eligible for androgen deprivation therapy.
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Affiliation(s)
- Zinelabidine Abouelfadel
- Urologic Oncology, University of Colorado Cancer CenterAurora, CO, USA
- Currently, Amiri Hospital Kuwait University, Urology SectionKuwait City
| | - E David Crawford
- Urologic Oncology, University of Colorado Cancer CenterAurora, CO, USA
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Shiota M, Tokuda N, Kanou T, Yamasaki H. Injection-site granulomas resulting from the administration of both leuprorelin acetate and goserelin acetate for the treatment of prostatic cancer. J NIPPON MED SCH 2007; 74:306-8. [PMID: 17878701 DOI: 10.1272/jnms.74.306] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although injection-site granulomas caused by leuprorelin acetate have been reported, there have been no reports of granulomas caused by both leuprorelin acetate and goserelin acetate. An 81-year-old man presented with subcutaneous nodules of the abdominal wall and upper arm, where 11.25 mg of leuprorelin acetate had been injected for the treatment of prostate cancer. Because of these nodules, treatment was changed to goserelin acetate. Nevertheless, he presented with another subcutaneous nodule at the injection site. Histological examination showed that these nodules consisted of numerous giant cells that were CD3-positive T lymphocytes and CD68-positive histiocytes associated with granulomatous changes. The granulomas had likely been caused by delayed-type hypersensitivity to leuprorelin acetate injection. The granuloma that formed after goserelin acetate injection might thus have developed owing to the immunogenicity of the previous leuprorelin acetate injections. The patient underwent surgical castration. The present case suggests that both leuprorelin acetate and goserelin acetate can cause injection-site disorders.
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Affiliation(s)
- Masaki Shiota
- Department of Urology and Pathology, Saga Prefectural Hospital, Koseikan, Saga, Japan.
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Vieu C, Arnault JP, Petitpain N, Cuny JF, Barbaud A, Plenat F, Schmutz JL. Granulome sur le site d’injection de leuproréline retard : réaction à corps étranger à l’excipient ? Ann Dermatol Venereol 2007; 134:771-3. [DOI: 10.1016/s0151-9638(07)92536-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shiota M, Tokuda N, Kanou T, Yamasaki H. Incidence rate of injection-site granulomas resulting from the administration of luteinizing hormone-releasing hormone analogues for the treatment of prostatic cancer. Yonsei Med J 2007; 48:421-4. [PMID: 17594149 PMCID: PMC2628105 DOI: 10.3349/ymj.2007.48.3.421] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Granulomas resulting from the administration of luteinizing hormone-releasing hormone analogues (LH-RH analogues) are thought to be very rare. We report on our clinical experience with injection-site granulomas that result from the administration of LH-RH analogues, and we evaluate the incidence rate of these granulomas. MATERIALS AND METHODS We used the clinical records of 118 patients who were administered LH-RH analogues in 2005. We describe the clinical data of patients who experienced injection-site granulomas and evaluated the incidence rate. RESULTS Five patients demonstrated injection-site granulomas due to LH-RH analogue administration. The incidence rate was 4.2% (5 of 118 patients). Most of the granulomas occurred after the first or second administration of 11.25mg of leuprorelin acetate. CONCLUSION The occurrence of granulomas resulting from the administration of LH-RH analogues was thought to be very rare. Our study, however, revealed a higher incidence rate than expected, especially for leuprorelin acetate.
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Affiliation(s)
- Masaki Shiota
- Department of Urology, Saga Prefectural Hospital, 1-12-9, Mizugae, Saga, 840-0054, Japan.
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Dangle P, Palit V, Sundaram SK, Weston P. Noninfective Cutaneous Granuloma with Leuprorelin Acetate—Reality or Myth. Urology 2007; 69:779.e5-6. [PMID: 17445679 DOI: 10.1016/j.urology.2007.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 12/23/2006] [Accepted: 02/08/2007] [Indexed: 11/16/2022]
Abstract
We present our experience with 7 patients who developed injection site granuloma with leuprorelin acetate injection. Although isolated case reports exist, this is the largest collection of cases from a single center. The exact mechanism of the granuloma formation is not well understood, although theories are associated with the vehicle used for injection. Our discussion focuses on the nature of the granuloma formation and its etiology. The reaction appears to be more common with leuprorelin acetate than with other forms of luteinizing hormone-releasing hormone analogues.
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Affiliation(s)
- Pankaj Dangle
- Department of Urology, Pinderfield General Hospital, Wakefield, United Kingdom.
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Ouchi T, Koyama T, Miyata N, Sugiura M. Granuloma caused by subcutaneous injection of leuprorelin acetate product: Case report and histopathological findings. J Dermatol 2006; 33:719-21. [PMID: 17040504 DOI: 10.1111/j.1346-8138.2006.00167.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Leuprorelin acetate is a luteinizing hormone-releasing hormone (LH-RH) analog, which is used for chemical castration. Chemical castration treatment has an especially important role for prostate cancer. To ensure ongoing chemical castration, a novel sustained-action injection system using spherical microcapsules has been developed. We report a patient who had granuloma caused by administration of the 11.25 mg leuprorelin acetate product. Histological examination revealed many giant cells with vacuoles. On the basis of reported cases, these vacuoles are characteristic for the granuloma caused by leuprorelin acetate product. The vacuoles in the granuloma are the same size as the microcapsules, and their shape is almost spherical. We assume that the vacuoles in the granuloma are actually the microcapsules. We expect that there will be investigations regarding the procatarctic cause of granuloma formation.
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Affiliation(s)
- Takeshi Ouchi
- Department of Dermatology, The Shizuoka Municipal Shimizu Hospital, Shimizu, Miyakami 1231, Shizuoka, Japan.
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Koupparis AJ, Tyrrell C. Non-suppression of Testosterone in Patients with a Rising Prostate-specific Antigen Level Receiving Luteinising Hormone-releasing Hormone Analogues for Metastatic Prostate Cancer. Clin Oncol (R Coll Radiol) 2006; 18:571-2. [PMID: 16972347 DOI: 10.1016/j.clon.2006.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Koupparis AJ. Re: Olav Erich Yri, Trine Bjoro and Sophie D. Fossa. Failure to achieve castration levels in patients using leupoprolide acetate in locally advanced prostate cancer. Eur Urol 2006;49:54-8. Eur Urol 2006; 50:626-7. [PMID: 16750291 DOI: 10.1016/j.eururo.2006.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2006] [Accepted: 04/21/2006] [Indexed: 10/24/2022]
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Sakamoto R, Higashi Y, Mera K, Kanekura T, Kanzaki T. Granulomas induced by subcutaneous injection of leuprorelin acetate. J Dermatol 2006; 33:43-5. [PMID: 16469084 DOI: 10.1111/j.1346-8138.2006.00008.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Leuprorelin acetate, a chemotherapeutic agent used to treat prostate cancer, is a synthetic luteinizing hormone-releasing hormone (LHRH) agonist. We report a 75-year-old man who presented with several large subcutaneous nodules at the site of leuprorelin acetate injections for his prostatic cancer. A biopsy of the nodules disclosed epithelioid granulomatous inflammation and resulted in a diagnosis of drug-induced granulomatous reaction to leuprorelin acetate.
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Affiliation(s)
- Ryoko Sakamoto
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
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Caron P, Cogne M, Raingeard I, Bex-Bachellerie V, Kuhn JM. Effectiveness and tolerability of 3-year lanreotide Autogel treatment in patients with acromegaly. Clin Endocrinol (Oxf) 2006; 64:209-14. [PMID: 16430722 DOI: 10.1111/j.1365-2265.2006.02450.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE During short-term treatment, monthly subcutaneous injections of lanreotide Autogel are effective in controlling GH/IGF-1 hypersecretion and are well tolerated in patients with acromegaly. This study reports the effectiveness and the tolerability of lanreotide Autogel for at least 3 years in acromegalic patients. PATIENTS Fourteen patients (nine females, five males) were treated with titrated doses of lanreotide Autogel. DESIGN This clinical study was an extension of a previous trial. After three fixed-dose lanreotide Autogel injections, treatment was adjusted according to mean GH and IGF-I levels. After 3 years of treatment, patients were receiving 120 (n=7), 90 (n=2) and 60 mg (n=4) monthly injections of lanreotide Autogel. MEASUREMENTS Acromegalic symptoms, GH and IGF-1 concentrations were analysed at the end of lanreotide microparticle treatment, and after 4, 8, 12, 24, 30 and 36 months of lanreotide Autogel therapy. Tolerance and side-effects were monitored throughout the 3-year study. RESULTS Hormonal control (GH <or= 2.5 microg/l and age- and sex-normalized IGF-1) was achieved in six (46%) patients. With the exception of an unrelated death due to pulmonary embolism, no patient withdrew from study. The number of patients reporting digestive adverse events was seven (12 episodes) for the fixed-dose period, and four (eight episodes), two (six episodes) and one (three episodes) at the end of the first, second and third year of treatment, respectively. Persistent induration at the injection sites was reported by two patients, and histological findings were consistent with benign injection-site granulomas. New cholelithiasis or sludge occurred in five (35%) patients during the lanreotide Autogel treatment. CONCLUSION This 3-year study shows that lanreotide Autogel is effective in controlling GH/IGF-1 hypersecretion and is well tolerated during long-term treatment of patients with acromegaly.
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Yasukawa K, Sawamura D, Sugawara H, Kato N. Leuprorelin acetate granulomas: case reports and review of the literature. Br J Dermatol 2005; 152:1045-7. [PMID: 15888168 DOI: 10.1111/j.1365-2133.2005.06341.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Leuprorelin acetate, an agonist of gonadotropin-releasing hormone (GnRH), is indicated in the treatment of prostate cancer. Recently, depot formulations of leuprorelin acetate have been widely used. We report three patients who showed a granulomatous reaction after treatment using a leuprorelin acetate 3-month depot formulation. These patients presented with 5-6-cm subcutaneous nodules at injection sites, which developed after the depot type was changed from a 1-month to a 3-month formulation. Skin biopsy showed epithelioid cells and foreign body giant cells containing round, translucent microspheres which formed sarcoidal granulomas. Changing to other GnRH agonists resulted in no further problems. We have reviewed the previous reports of leuprorelin acetate-induced granuloma formation. The formation of such granulomas may be related to the polymers that allow slow release after injection, or leuprorelin acetate itself may be responsible. The depot injection methods using leuprorelin also seem to have a causal effect in granuloma formation. Dermatologists need to know that depot leuprorelin acetate may cause a granulomatous reaction which produces a subcutaneous nodule that might be misdiagnosed as a malignant tumour.
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Affiliation(s)
- K Yasukawa
- Department of Dermatology, National Hospital Organization Hokkaido Cancer Centre, Sapporo, Hokkaido, Japan
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Saxby M. Leuprorelin acetate granulomas: recurrent subcutaneous nodules mimicking metastatic deposits at injections sites. BJU Int 2003; 91:125. [PMID: 12614269 DOI: 10.1046/j.1464-410x.2003.t01-1-04022.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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