Cerebrospinal fluid rhinorrhoea during treatment of pituitary tumours with bromocriptine

Abstract

Abstract. Bromocriptine is widely used in the treatment of hyperprolactinaemia. It has also been shown to be effective in reducing the size of large pituitary tumours, particularly those secreting prolactin. We describe CSF rhinorrhoea in two such patients during treatment with bromocriptine and believe that this complication developed as a result of contraction of the tumour exposing a defect in the sella floor. The possibility of this complication, especially in patients with downward extension of tumour, should be noted.

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

“…In such cases the tumor often herniates into the bone defect and acts as a "plug", preventing CSF leak. 4,7,12 Partial or total removal of tumor may cause CSF leakage by "unplugging" the defect, as can shrinkage of the tumor by radiotherapy. Since bromocriptine also diminishes tumor size, it may have a similar effect (Figure 4).…”

“…In addition, a firm bed can be created for a graft, and this may prove useful if a subsequent transcranial approach becomes necessary. 12 At the second operation, we supplemented our fascia lata and fibrin glue repair with methylmethacrylate because of the extensive bone destruction. Although the use of foreign materials in this situation may increase the risk of infection and is not generally recommended, it proved useful in our patient and had no untoward effect.…”

“…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.…”

“…5,7,10,11 Three were chromophobe adenomas. 6,12 Two were reported as "pituitary adenoma". 4,9 In two, the pathology is not recorded 4,6 and in one, only necrotic tissue was obtained.…”

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] .…”