Bromocriptine-induced cerebrospinal fluid fistula in patients with macroprolactinomas: Report of three cases and a review of the literature

Barlas, Orhan; Bayindir, Çiçek; Hepgül, Kemal; Can, Meltem Güner; Kırış, Talat; E, Sencer; Ünal, Faruk; Aral, Feríhan

doi:10.1016/0090-3019(94)90013-2

Cited by 32 publications

(26 citation statements)

References 11 publications

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“…The second was promptly resolved with transsphenoidal surgery. 2 Finally, CSF rhinorrhea occurred spontaneously as the presenting symptom of pituitary adenoma in 14 cases, of which 7 resolved with surgical repair via a transsphenoidal approach, and 2 resolved with unknown operations. 3,5,8,18,20,21,25,26 In 1 patient, a temporary lumbar drain was successfully used as the only definitive treatment.…”

Section: Treatment Characteristics In Patients With Csf Leaks and Undmentioning

confidence: 99%

Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature

Lam¹,

Mehta²,

Zada³

2012

FOC

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Object Spontaneous and medically induced CSF leaks are uncommonly associated with pituitary adenomas. The aim of this study was to further characterize the clinical scenarios most closely associated with this phenomenon. Methods A review of the literature was conducted to identify all cases of nonsurgical CSF leaks associated with pituitary adenomas. The authors aimed to identify associated risk factors and management strategies used to treat these tumors and repair the CSF leak site. Results Fifty-two patients with spontaneous or medically induced CSF leaks in the setting of a pituitary adenoma were identified from 29 articles published from 1980 through 2011. In 38 patients (73%), CSF rhinorrhea developed following initiation of medical therapy, whereas spontaneous CSF leakage developed as the presenting symptom in 14 patients (27%). The patients' mean age was 42.8 years (range 23–68 years). There were 35 males and 17 females. Forty-two patients (81%) had a prolactinoma, with the remaining patients having the following tumors: nonfunctioning pituitary adenoma (6 patients), growth hormone–secreting adenoma (2 patients), mammosomatotroph cell adenoma (1 patient), and ACTH-secreting adenoma (1 patient). Infrasellar tumor invasion into the paranasal sinuses was specifically reported in 56% of patients. The medical agents associated with CSF leakage were dopamine agonists (97%) and somatostatin analogs (3%). The average time from initialization of medical treatment to onset of rhinorrhea was 3.3 months (range 3 days–17 months). Nonsurgical management was successful in 4 patients, including 1 who had successful resolution with a temporary lumbar drain. Forty-six patients (88%) underwent surgical intervention to treat the CSF leak and/or resect the tumor. In 2 patients, surgery was not performed due to medical contraindications or patient preference. Conclusions Nonsurgical development of CSF rhinorrhea may occur in the setting of pituitary adenomas, especially following favorable response of invasive prolactinomas to initiation of dopamine agonist therapy. Additional cases have been reported as the presenting symptom of a pituitary adenoma and are likely to be related to decreased tumor volume due to intrinsic infarction or hemorrhage, ongoing invasion, and/or increases in intracranial pressure. Surgical repair, preferentially via a transsphenoidal approach, is the recommended initial treatment for definitive repair of the CSF leak and achievement of maximal tumor resection.

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Section: Treatment Characteristics In Patients With Csf Leaks and Undmentioning

confidence: 99%

Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature

Lam¹,

Mehta²,

Zada³

2012

FOC

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“…This repair added safety to bromocriptine use, once bromocriptine is a well-known cause of fistula and it must be stopped when fistula occurs secondarily to its use 25 . The prompt surgical exploration and closure of a skull base defect is imperative in order to have a good result 3,6,25,26 . We agree to previous reports stressing that the treatment of choice should be direct surgery to remove tumor, repair dura and make definitive diagnosis 22,25 .…”

Section: Discussionmentioning

confidence: 99%

“…Rhinorrhea occuring during primary treatment of prolactinomas with bromocriptine is also well recognized 6,[9][10][11][12][13][14] . Nevertheless, it is a rare condition in untreated patients; to our knowledge, only 15 well-documented cases have been reported [15][16][17][18][19][20][21][22][23] .…”

mentioning

confidence: 99%

“…Cerebrospinal fluid (CSF) fistula is a rare complication of skull base erosion by pituitary tumors and may occur after transsphenoidal surgery and has been reported in patients operated upon by this approach [1][2][3] , radiotherapy 1,3,4 , adjuvant bromocriptine use with such procedures [5][6][7][8][9] . Rhinorrhea occuring during primary treatment of prolactinomas with bromocriptine is also well recognized 6,[9][10][11][12][13][14] .…”

mentioning

confidence: 99%

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Cerebrospinal fluid fistula as the presenting manifestation of pituitary adenoma: case report with a 4-year follow-up

Hanel

Prevedello

Correa

et al. 2001

Arq. Neuro-Psiquiatr.

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We report the case of a young woman who presented with cerebrospinal fluid (CSF) rhinorrhea due to an undiagnosed and untreated pituitary adenoma. The tumor had extended well beyond sella turcica and caused bony erosion. The patient initially refused surgery and was treated with bromocriptine and a radiation therapy. CSF leakage did not improved and she was submitted to surgery by the transsphenoidal approach with removal of a tumor mass located in sphenoid sinus and sellar region. Origin of the leak was localized and repaired with fascia lata and a lumbar subarachnoid drain was left in place for 5 days. After 4 years she has normal serum PRL levels and no rhinorrhea. The management, complications and mechanisms involved in this rare condition are discussed.

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“…With shrinkage of the macroprolactinoma, cerebrospinal fluid leakage and subsequent meningitis may occur as complications. 19 The growth hormone (GH)-producing pituitary adenomas have a unique MR feature compared with non-GH-producing adenomas (Fig. 7).…”

Section: Pituitary Adenomamentioning

confidence: 99%

Imaging diagnosis and fundamental knowledge of common brain tumors in adults

Tanaka¹

2006

Radiat Med

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The most common primary brain tumors in Japanese adults are meningiomas, gliomas, pituitary adenomas, and schwannomas, which together account for 84.0% of all primary brain tumors. The typical imaging findings of these tumors are well known by radiologists; therefore, the clinical and pathological issues, including terminology, genetics, and relation to hormones are discussed in this article. Other diseases important for the differential diagnoses are also mentioned. The molecular genetic analysis of brain tumors has recently become important. For instance, genetic analysis is important for differentiating oligodendroglial tumors from astrocytic tumors, and the gene mutation predicts response to chemotherapy for anaplastic oligodendrogliomas. Background factors such as hormones, history of cranial irradiation, and medications influence oncogenesis, tumor growth, and tumor appearances as seen by imaging modalities. A differential diagnosis with knowledge of the above may have some advantages over diagnoses based on imaging findings alone. Nonneoplastic diseases such as abscesses and demyelinating diseases may mimic gliomas. Pituitary adenomas may be confused with nonneoplastic conditions such as physiological hypertrophy and Rathke's cleft cyst. Such misdiagnoses would result in a treatment protocol very different from what would be suitable. Such conditions should be carefully distinguished from neoplasms.

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Bromocriptine-induced cerebrospinal fluid fistula in patients with macroprolactinomas: Report of three cases and a review of the literature

Cited by 32 publications

References 11 publications

Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature

Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature

Cerebrospinal fluid fistula as the presenting manifestation of pituitary adenoma: case report with a 4-year follow-up

Imaging diagnosis and fundamental knowledge of common brain tumors in adults

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