Cerebrospinal fluid rhinorrhea caused by bromocriptine therapy of prolactinoma

Abstract

We studied a man with cerebrospinal fluid rhinorrhea due to bromocriptine-induced shrinkage of a prolactin-secreting pituitary tumor. Unlike other reported cases with pituitary tumors and rhinorrhea, our patient never had previous radiotherapy or surgery. The fistula was clearly demonstrated by CT. The original signs included homonymous hemianopia due to a left optic tract compression. Bromocriptine treatment is an invaluable adjunct in long-term management of invasive prolactinomas, but surgical intervention is indicated if a CSF fistula results.

Bromocriptine-Induced Cerebrospinal Fluid Rhinorrhea in Invasive Prolactinoma: Case Report and Review of the Literature

“…Two had transcranial repair. 7,10 Our patient and one other 9 required a second operation because of recurrent CSF leak. …”

“…Thus, CSF rhinorrhea due to the "unplugging" phenomenon may result from any treatment that reduces tumor size when bone destruction is present. 7,10,11 Surgical treatment of CSF rhinorrhea in the presence of invasive pituitary tumors is difficult since the tumor is extensive and all of it cannot be removed. The transsphenoidal route is the preferred one for repair.…”

“…In addition to ours, seven cases had only bromocriptine treatment before the CSF leak developed. [8][9][10][11][12] Eight cases had additional forms of treatment; one had transsphenoidal surgery, 4 four had transsphenoidal surgery plus radiotherapy, 5,7 one had radiotherapy, 7 one had transcranial surgery 6 and one had transnasal biopsy of the tumor. 13 However, none of these had CSF rhinorrhea until the addition of bromocriptine to the treatment.…”

“…11 In seven cases as well as ours, the pathological studies confirmed the tumor to be a prolactinoma. 5,7,10,11 Three were chromophobe adenomas. 6,12 Two were reported as "pituitary adenoma".…”

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

“…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] .…”