leuprolide and Myocardial-Infarction

Several abstracts presented at the 2015 European Association of Urology Meeting highlighted new developments in hormone therapy for prostate cancer management. One abstract described how the luteinizing hormone-releasing hormone (LHRH)/gonadotropin-releasing hormone (GnRH) agonist leuprolide, but not the LHRH/GnRH antagonist degarelix, induced plaque instability in a mouse model. A second abstract showed that in patients with a history of severe cardiovascular disease, degarelix was associated with fewer cardiovascular events than treatment with an LHRH agonist. A third abstract showed how primary androgen-deprivation therapy was linked with increased all-cause mortality in a US registry. A fourth abstract showed that in the ANAMEN study, cognitive performance was not significantly affected by 6 months of treatment with GnRH agonists. Last, a fifth abstract showed that low-dose prednisone, with or without abiraterone, was associated with an overall low incidence of corticosteroid-associated adverse events.

Topics: Abiraterone Acetate; Animals; Antineoplastic Agents, Hormonal; Antineoplastic Combined Chemotherapy Protocols; Cognition; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Luteinizing Hormone; Male; Mice; Mortality; Myocardial Infarction; Oligopeptides; Prednisone; Prostatic Neoplasms; Risk Assessment; Stroke

Two previous reports have reported myocardial infarction during ovarian hyperstimulation syndrome, a complication of controlled ovarian stimulation characterized by ascites, pleural effusion, hemoconcentration and an increased thromboembolic risk, but no association with the initial phase (before treatment with human chorionic gonadotropin) of a normal ovarian stimulation protocol for infertility has ever been described. We report the first case, to our knowledge, of acute myocardial infarction occurring during the initial phase of an otherwise uncomplicated ovarian stimulation protocol. A young woman with infertility associated to polycystic ovary syndrome was treated with leuprolide acetate and recombinant follicle stimulating hormone to induce ovarian stimulation for in vitro fertilization and embryo transfer. After 12 days the patient presented a non-ST elevation myocardial infarction, which was treated with aspirin, clopidogrel, enoxaparin, intravenous nitrates and beta blockers. Cardiac catheterization showed angiographically normal coronary arteries. Echocardiography showed a circumscribed akinesis of the inferior apical segment of the left ventricle and right ventricular apex, which was confirmed by cardiac magnetic resonance. A screening for thrombophilic diathesis was negative. The patient was discharged and remained asymptomatic at 1 and 3 months follow up. Further ovarian stimulations were excluded and a trial of oocyte retrieval on spontaneous cycle was planned. Myocardial infarction can complicate ovarian stimulation protocols for infertility even in their early phase without any sign of ovarian hyperstimulation syndrome.

Topics: Adult; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Leuprolide; Myocardial Infarction; Obesity; Ovulation Induction; Polycystic Ovary Syndrome

Macro CK (creatine kinase) as a reason for high CK values has been known since 1979. Even in the era of troponin determination for the diagnosis of myocardial infarction, an elevated CK value can still cause confusion, especially as CK-MB rises earlier than troponin. The case report should remind us of this often forgotten differential diagnosis of elevated CK.. A 73-year-old patient was treated with leuprorelin hormone therapy for prostate cancer (stage pT1c G2). In addition, he received percutaneous radiation therapy of the prostate and high-dose-rate brachytherapy twice with 10 Gy each. Close to 1 year later, he complained for the first time of dyspnea on exertion and thoracic tightness. Serum CK was 232 U/l, and CK-MB 62 U/l, which was confirmed by several controls. Troponin T test was negative, and GOT, GPT, LDH, and PSA were all within the normal range. Acute myocardial infarction was ruled out on clinical grounds and by six sequential ECGs. Subsequently, the patient remained without further cardiac complaints and in good condition. Isoenzyme electrophoresis finally solved the problem and revealed CK-BB-IgG complex type 1 (macro CK-1).. High CK-MB values in cardially healthy patients should remind us of the possibility of macro CK which is seen in approximately 0.5% of cases and should be included in the differential diagnosis.

Topics: Adenocarcinoma; Aged; Antigen-Antibody Complex; Antineoplastic Agents, Hormonal; Brachytherapy; Chest Pain; Combined Modality Therapy; Creatine Kinase; Creatine Kinase, MB Form; Diagnosis, Differential; Electrocardiography; Humans; Immunoglobulin G; Isoenzymes; Leuprolide; Macromolecular Substances; Male; Myocardial Infarction; Neoplasm Staging; Prostatic Neoplasms; Radiotherapy, Adjuvant

Topics: Angina Pectoris; Female; Humans; Leuprolide; Myocardial Infarction; Risk Factors

Use of leuprolide acetate (Lupron) has been associated with angina in men, but there have been no previous reports of angina or myocardial infarction associated with its use in women. The first case of angina and myocardial infarction occurring in a woman undergoing treatment with leuprolide acetate depot is reported.

Topics: Adult; Angina Pectoris; Female; Humans; Leiomyoma; Leuprolide; Myocardial Infarction; Uterine Neoplasms