SpontaneouS intracranial hypotension is an important cause of new, daily, persistent headaches that usually afflicts young to middle-aged adults, with a female predominance and a peak incidence in the 5th decade of life. 16 The headache is typically orthostatic and is often accompanied by nausea, neck pain, and hearing abnormalities. Spontaneous intracranial hypotension is uncommon, with an estimated incidence of approximately 5 per 100,000 per year. The cause of spontaneous intracranial hypotension is almost always a spontaneous spinal CSF leak, and a systemic connective tissue disorder affecting the spinal dura mater is often suspected.14 In spontaneous intracranial hypotension, pituitary enlargement is one of the 5 main imaging features that can be found on brain MRI (Sagging of the brain, Enhancement of the pachymeninges, Engorgement of venous structures, Pituitary enlargement, and Subdural fluid collections [SEEPS]).
16Pituitary enlargement in spontaneous intracranial hypotension has now been well documented and can resemble a pituitary tumor. 2,9,11,13,18 Moreover, sagging of the brain often is associated with distortion of the pituitary stalk. However, a systematic evaluation of pituitary function has not been reported in patients with spontaneous intracranial hypotension. Therefore, we investigated pituitary hormones in patients with this disorder. OBJect Spontaneous intracranial hypotension is an increasingly recognized cause of headaches. Pituitary enlargement and brain sagging are common findings on MRI in patients with this disorder. The authors therefore investigated pituitary function in patients with spontaneous intracranial hypotension. MethODS Pituitary hormones were measured in a group of 42 consecutive patients with spontaneous intracranial hypotension. For patients with hyperprolactinemia, prolactin levels also were measured following treatment. Magnetic resonance imaging was performed prior to and following treatment. reSultS The study group consisted of 27 women and 15 men with a mean age at onset of symptoms of 52.2 ± 10.7 years (mean ± SD; range 17-72 years). Hyperprolactinemia was detected in 10 patients (24%), ranging from 16 ng/ml to 96.6 ng/ml in men (normal range 3-14.7 ng/ml) and from 31.3 ng/ml to 102.5 ng/ml in women (normal range 3.8-23.2 ng/ml). In a multivariate analysis, only brain sagging on MRI was associated with hyperprolactinemia. Brain sagging was present in 60% of patients with hyperprolactinemia and in 19% of patients with normal prolactin levels (p = 0.02). Following successful treatment of the spontaneous intracranial hypotension, hyperprolactinemia resolved, along with normalization of brain MRI findings in all 10 patients. cONcluSiONS Spontaneous intracranial hypotension is a previously undescribed cause of hyperprolactinemia. Brain sagging causing distortion of the pituitary stalk (stalk effect) may be responsible for the hyperprolactinemia.
Methods