Prolactinoma extension as a contributing factor in dopamine agonist-induced CSF rhinorrhea: a systematic review of the literature

Milton, Camille K; Lee, Benjamin J.; Voronovich, Zoya; Conner, Andrew K.; McKinney, Kibwei A.; Rassi, Edward T. El; Lim, Jonea; Glenn, Chad A.

doi:10.1080/02688697.2021.1903389

Cited by 2 publications

(5 citation statements)

References 32 publications

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“…The development of spontaneous CSF rhinorrhoea prior to any treatment suggests an interaction between a tumour effect and a drug effect in the pathogenesis of this complication (Suliman et al 2007). Risk factors for DA-associated CSF rhinorrhoea include male gender, DA resistance and sphenoid sinus invasion (Suliman et al 2007, Milton et al 2021). Surgical intervention is required in most cases of CSF rhinorrhoea in order to repair the dural defect and stop the CSF leak (Suliman et al 2007).…”

Section: Csf Rhinorrhoeamentioning

confidence: 99%

“…CSF rhinorrhoea arises when an invasive prolactinoma creates a CSF fistula through the dura and osseous skull base, followed by DA-induced tumour shrinkage and unmasking of the skull base defect, resulting in a clear nasal drip of CSF ( Suliman et al 2007 , Milton et al 2021 ). CSF rhinorrhoea may occur anytime from 1 week to 5 years after initiation of DA therapy ( Milton et al 2021 ). Potentially fatal complications include meningitis, intracranial abscess and pneumocephalus ( Suliman et al 2007 ).…”

Section: Risks Of Dopamine Agonist Therapymentioning

confidence: 99%

“…In the absence of recommendations from the existing international prolactinoma guidelines, it is reasonable to warn and clinically monitor patients considered to be at high risk of CSF rhinorrhoea. Thin-slice CT imaging of the sinus may help delineate the extent of osseous involvement in patients with sphenoid sinus invasion seen on MRI, thereby identifying patients requiring closer monitoring for CSF rhinorrhoea ( Milton et al 2021 ). However, it is not yet clear if this can be used to guide pre-emptive surgical intervention ( Milton et al 2021 ).…”

Section: Risks Of Dopamine Agonist Therapymentioning

confidence: 99%

“…Thin-slice CT imaging of the sinus may help delineate the extent of osseous involvement in patients with sphenoid sinus invasion seen on MRI, thereby identifying patients requiring closer monitoring for CSF rhinorrhoea ( Milton et al 2021 ). However, it is not yet clear if this can be used to guide pre-emptive surgical intervention ( Milton et al 2021 ). Beta-2-transferrin should be measured in any suspicious nasal discharge in order to diagnose CSF rhinorrhoea ( Suliman et al 2007 ).…”

Section: Risks Of Dopamine Agonist Therapymentioning

confidence: 99%

“…Beta-2-transferrin should be measured in any suspicious nasal discharge in order to diagnose CSF rhinorrhoea ( Suliman et al 2007 ). Patients with confirmed CSF rhinorrhoea should be referred for surgical review, noting that surgical correction is not necessarily required and DA therapy may potentially be continued with – or even without – surgical intervention ( Netea-Maier et al 2006 , Suliman et al 2007 , Milton et al 2021 ). Pending prospective studies in this area, patients should be managed on a case-by-case basis.…”

Section: Risks Of Dopamine Agonist Therapymentioning

confidence: 99%

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Dopamine agonist therapy for prolactinomas: do we need to rethink the place of surgery in prolactinoma management?

Sousa

2022

Endocrine Oncology

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The current treatment paradigm for prolactinomas involves dopamine agonist (DA) therapy as the first-line treatment, with surgical resection reserved for cases where there is DA failure due to resistance or intolerance. This review highlights how DA therapy can be optimised to overcome its increasingly recognised pitfalls, whilst also addressing the potential for expanding the use of surgery in the management of prolactinomas. The first part of the review discusses the limitations of DA therapy, namely: DA resistance; common DA side effects; and the rare but serious DA-induced risks of cardiac valvulopathy, impulse control disorders, psychosis, CSF rhinorrhoea and tumour fibrosis. The second part of the review explores the role of surgery in prolactinoma management with reference to its current second-line position and recent calls for surgery to be considered as an alternative first-line treatment alongside DA therapy. Randomised trials comparing medical versus surgical therapy for prolactinomas are currently underway. Pending these results, a low surgical threshold approach is herein proposed, whereby DA therapy remains the default treatment for prolactinomas unless there are specific triggers to consider surgery, including concern regarding DA side effects or risks in vulnerable patients, persistent and bothersome DA side effects, emergence of any serious risks of DA therapy, expected need for long-term DA therapy, as well as the traditional indications for surgery. This approach should optimise the use of DA therapy for those who will most benefit from it, whilst instituting surgery early in others in order to minimise the cumulative burden of prolonged DA therapy.

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