Spontaneous cerebrospinal fluid rhinorrhea associated with an incidental pituitary adenoma

Chu, Xiaoshuai; Zhang, Yongna; Tuo, Lei; Cui, Lihong; Zhang, Ping; Yuan, Xunhui; Guo, Liemei

doi:10.1080/02688697.2019.1587384

Cited by 4 publications

(10 citation statements)

References 12 publications

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“… 17 , 19 , 20 Chu et al reported a case in which a small pituitary adenoma was accidentally found when repairing spontaneous CSF rhinorrhea. 6 In the present patient, although the tumor was not as large as the one in the previously reported case, pituitary apoplexy that might involve PS formation, as described above, resulted in partial necrosis of the tumor cells and led to CSF collection into the sella turcica. Then, initial CSF leakage occurred through disruption of the dura, which had been thinned by the tumor mass.…”

Section: Discussionsupporting

confidence: 46%

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Pituitary stone resulting in visual dysfunction and spontaneous rhinorrhea in nonfunctioning pituitary adenoma: illustrative case

Kanemitsu¹,

Ikeda²,

Fukumura³

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUNDCalcifications in pituitary adenomas are rare, being found in only 5.4%–25% of reported cases. These are divided into eggshell-like calcifications around the tumor and nodular calcifications at the center of the tumor, the latter of which are called “pituitary stones” (PSs).OBSERVATIONSThe authors report the case of a 60-year-old male with a nonfunctional pituitary adenoma with PSs and asymptomatic ventricular dilatation who presented with spontaneous cerebrospinal fluid (CSF) rhinorrhea and rapid visual aggravation without an increase in tumor size over the course of 4 years. After endoscopic transnasal surgery, his visual acuity immediately improved temporarily. It was believed that the increased intracranial pressure due to secondary hydrocephalus resulted in visual aggravation; thus, a ventriculoperitoneal (VP) shunt was created. After creation of the VP shunt, the patient’s visual acuity improved gradually and completely. Histological findings showed that adenoma cells were observed among the lamellar bone trabeculae. To the best of the authors knowledge, this is the first report of osteoid metaplasia–type PSs in nonfunctioning pituitary adenoma.LESSONSPSs formed near the sellar floor and caused spontaneous CSF rhinorrhea due to direct mechanical stress on the dura mater and optic nerves, which may have caused meningitis and secondary hydrocephalus that resulted in visual impairment independent of tumor size.

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Section: Discussionsupporting

confidence: 46%

“…[1][2][3][4][5] Furthermore, spontaneous cerebrospinal fluid (CSF) rhinorrhea in patients with untreated pituitary adenomas is extremely rare, with only 16 cases having been reported in the Englishlanguage literature. 6 We report a unique symptomatic nonfunctioning pituitary adenoma that exhibited these 2 rare conditions, and we review the relevant literature.…”

mentioning

confidence: 99%

Pituitary stone resulting in visual dysfunction and spontaneous rhinorrhea in nonfunctioning pituitary adenoma: illustrative case

Kanemitsu¹,

Ikeda²,

Fukumura³

et al. 2021

Journal of Neurosurgery: Case Lessons

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“…e spontaneous CSF rhinorrhea in pituitary adenoma without treatment reported 16 cases in 13 English literatures. [1,2,4,6,7,9,10,12,[18][19][20][21]24] Including our cases, description of clinical features of these cases is listed in Table 1. In the literature reported so far, the CSF leak was resolved using fat, tensor fascia lata, etc.…”

Section: Discussionmentioning

confidence: 99%

“…erefore, the flow and pulsation of CSF tend to pass through the anatomically weak area of the skull base, which can cause spontaneous CSF rhinorrhea. [6,10,19] e spontaneous CSF rhinorrhea is often mistaken for allergic rhinitis of chronic sinusitis, resulting in delayed diagnosis or inappropriate management. Duration of spontaneous CSF rhinorrhea in these cases is long.…”

Section: Discussionmentioning

confidence: 99%

Treatment of pituitary adenoma with spontaneous cerebrospinal rhinorrhea using nasoseptal flap, two case reports

Kang

Ryu

et al. 2022

Surgical Neurology International

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Background: Postoperative cerebrospinal fluid (CSF) leakages are well documented, but pituitary adenoma with spontaneous CSF rhinorrhea as the initial symptoms are extremely rare. The objective of this study is to report two rare cases of pituitary adenoma with spontaneous CSF rhinorrhea successfully operated by endoscopic transsphenoidal approach with vascularized nasoseptal flap (NSF). Case Description: A 70-year-old woman presented with a 6-month history of watery rhinorrhea and posterior nasal drip that worsened when her head leaning forward. Sella magnetic resonance image (MRI) demonstrated pituitary macroadenoma (3.4 × 2.7 cm) invading cavernous sinus, clivus, and sphenoid sinus. A 47-year-old woman presented with a 10-month history of watery rhinorrhea and posterior nasal drip. Sella MRI demonstrated pituitary macroadenoma (6.3 × 4.6 cm) invading cavernous sinus, clivus, sphenoid sinus, and middle fossa. Both patients underwent endoscopic endonasal transsphenoidal operation and skull base reconstruction with vascularized NSF. The postoperative clinical course was uneventful and CSF rhinorrhea disappeared completely. Conclusion: Pituitary adenoma should be suspected if there is a watery CSF rhinorrhea that occurs without a history of trauma or nasal disease. In addition, effective treatment can be performed using NSF, a technique for endoscopic skull base reconstruction.

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“…Additionally, in patients with PA who are not hormone-deficient, there are some reports of increased drowsiness and fatigue (14). Therefore, some researchers (15)(16)(17) believe that fatigue is associated with abnormal sleep rhythm, especially when the tumor is large enough to injury the upper nucleus, the circadian rhythm can be seriously damaged. Physical activity is often significantly associated with fatigue, and it is even considered as one of the measures to alleviate fatigue (18,19), but in the relevant reports of patients with PA, little attention is paid to physical activity.…”

Section: Original Articlementioning

confidence: 99%

The fatigue, sleep and physical activity in postoperative patients with pituitary adenoma: what we can do

Zhao¹,

Wang²,

Sheng³

et al. 2020

Transl Cancer Res TCR

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Background: To evaluate the current status of fatigue, sleep and physical activity in postoperative patients with pituitary adenoma (PA).Methods: Postoperative patients undergoing PA resection from November 2017 to November 2018 were identified. A multi-centered survey was conducted with questionnaires on the characteristics of included PA patients, multidimensional fatigue inventory (MFI-20), the Pittsburgh sleep quality index (PSQI) questionnaire, and the international physical activity (IPA) questionnaire. The related scores and potentially influencing factors were analyzed accordingly.Results: A total of 184 patients were included. The time course after operation, PSQI were correlated with the scores of general fatigue, physical fatigue, reduced activity and reduced motivation (all P<0.05); PSQI and IPA, the time course after operation and gender were the independent factors associated with the level of general fatigue (all P<0.05); PSQI, IPA and the time course after operation, adenoma size and gender were the independent factors influencing the level of physical fatigue (all P<0.05); the time course after operation, IPA, PSQI and gender were the independent factor influencing the level of reduced activity (all P<0.05); the time course after operation, IPA, PSQI and adenoma size were the independent factor influencing the level of reduced motivation (all P<0.05); the time course after operation was the independent factor influencing the level of mental motivation (P=0.030).Conclusions: Fatigue in PA patients after surgery is inversely associated with the time course after surgery and physical activity, future studies on the related interventions are warranted.

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Spontaneous cerebrospinal fluid rhinorrhea associated with an incidental pituitary adenoma

Cited by 4 publications

References 12 publications

Pituitary stone resulting in visual dysfunction and spontaneous rhinorrhea in nonfunctioning pituitary adenoma: illustrative case

Pituitary stone resulting in visual dysfunction and spontaneous rhinorrhea in nonfunctioning pituitary adenoma: illustrative case

Treatment of pituitary adenoma with spontaneous cerebrospinal rhinorrhea using nasoseptal flap, two case reports

The fatigue, sleep and physical activity in postoperative patients with pituitary adenoma: what we can do

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