{'fraction_non_alphanumeric': 0.03254237288135593, 'fraction_numerical': 0.013559322033898305, 'mean_word_length': 5.445414847161572, 'pattern_counts': {'":': 0, '<': 1, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Rapid onset of pituitary apoplexy after goserelin implant for prostate cancer: need for heightened awareness

A 67-year-old retired accountant presented 8 h after insertion of a goserelin (Zoladex 3.6 mg; Zeneca Pharmaceuticals Australia, Melbourne, Vic., Australia) subcutaneous implant with sudden visual loss and severe frontal headache. During the previous week, a routine screening rectal examination had revealed a prostatic mass. Transrectal biopsy confirmed prostate adenocarcinoma. The prostatespecific antigen level was elevated at 12.3 ng/mL (reference range < 4.6 ng/mL). Staging investigations included a computed tomography scan of the pelvis, which revealed an enlarged and irregular prostate with a soft tissue nodule immediately adjacent and possibly infiltrating the right lateral rectal wall, and a radionuclide whole-body bone scan, which did not reveal bony metastases. Hence, stage C (locally invasive) prostatic adenocarcinoma was diagnosed. He was prescribed cyproterone acetate 100 mg daily (Androcur; Schering Pty Ltd, Alexandria, NSW, Australia) and a goserelin 3.6 mg implant was inserted subcutaneously in the abdominal wall at approximately 12.00 midday. There were no preceding measures of prolactin or cortisol. He had no symptoms of hypogonadism. His past medical history included hypertension, gastro-oesophageal reflux and a left thigh melanoma excised 8 months prior to presentation (histology suggested that this was a complete excision).