CSF rhinorrhoea following treatment with dopamine agonists for massive invasive prolactinomas

Leong, King Sun; Foy, P. M.; Swift, A. C.; Atkin, Stephen L.; Hadden, David R.; MacFarlane, I. A.

doi:10.1046/j.1365-2265.2000.00901.x

Cited by 92 publications

(51 citation statements)

References 34 publications

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“…They may include cerebrospinal fluid leakage (24), chiasmal herniation, and pituitary apoplexy, none of which developed in our series, despite the high dose of cabergoline used in some of the patients. Some doses used are beyond those recommended in the package insert, but large doses are sometimes needed for certain patients with large tumors.…”

Section: Discussionmentioning

confidence: 81%

Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men

Shimon¹,

Benbassat²,

Hadani³

2007

eur j endocrinol

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Objective: To review our experience with cabergoline, a D2-selective dopamine agonist, for the treatment of giant prolactinomas. Design: A retrospective case series; descriptive statistics. Methods: The study group included 12 men aged 24-52 years (mean 39.2 years) treated for giant prolactinoma at our centers from 1997 to 2006. Cabergoline was started at a dose of 0.5 mg/three times a week and progressively increased as necessary to up to 7 mg/week. Patients were followed by hormone measurements, sellar magnetic resonance imaging, and visual examinations. Results: In ten patients, cabergoline served as first-line therapy. The other two patients had previously undergone transsphenoidal partial tumor resection because of visual deterioration. Mean serum prolactin level before treatment was 14 393G14 579 ng/ml (range 2047-55 033 ng/ml; normal 5-17 ng/ml). Following treatment, levels normalized in ten men within 1-84 months (mean, 25.3 months) and decreased in the other two to 2-3 times of normal. Tumor diameter, which measured 40-70 mm at diagnosis, showed a mean maximal decrease of 47G21%; response was first noted about 6 months after the onset of treatment. Nine patients had visual field defects at diagnosis; vision returned to normal in three of them and improved in five. Testosterone levels, initially low in all patients, normalized in eight. There were no side effects of treatment. Conclusion: Cabergoline therapy appears to be effective and safe in men with giant prolactinomas. These findings suggest that cabergoline should be the first-line therapy for aggressive prolactinomas, even in patients with visual field defects.European Journal of Endocrinology 156 225-231

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Section: Discussionmentioning

confidence: 81%

Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men

Shimon¹,

Benbassat²,

Hadani³

2007

eur j endocrinol

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“…2 Finally, CSF rhinorrhea occurred spontaneously as the presenting symptom of pituitary adenoma in 14 cases, of which 7 resolved with surgical repair via a transsphenoidal approach, and 2 resolved with unknown operations. 3,5,8,18,20,21,25,26 In 1 patient, a temporary lumbar drain was successfully used as the only definitive treatment. 37 In the remaining 4 cases, initial management with frontal craniotomies 12,23 or transsphenoidal surgery failed to resolve the leak.…”

Section: Treatment Characteristics In Patients With Csf Leaks and Undmentioning

confidence: 99%

“…Of these cases, rhinorrhea was ultimately resolved with a transsphenoidal approach in 3 patients, a transfrontal approach in 1 patient, lumboperitoneal shunt placement in 1 patient, and craniotomy in 1 patient, and it subsided without treatment in 1 patient. 10,13,17,24,25,28 In 2 cases, the rhinorrhea initially subsided with bed rest. Of these cases, the first recurred 3 three years later, even though treatment was uneventfully reinstated a month after the initial rhinorrhea episode ceased, and the recurrence subsided again with bed rest.…”

Section: Treatment Characteristics In Patients With Csf Leaks and Undmentioning

confidence: 99%

Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature

Lam¹,

Mehta²,

Zada³

2012

FOC

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Object Spontaneous and medically induced CSF leaks are uncommonly associated with pituitary adenomas. The aim of this study was to further characterize the clinical scenarios most closely associated with this phenomenon. Methods A review of the literature was conducted to identify all cases of nonsurgical CSF leaks associated with pituitary adenomas. The authors aimed to identify associated risk factors and management strategies used to treat these tumors and repair the CSF leak site. Results Fifty-two patients with spontaneous or medically induced CSF leaks in the setting of a pituitary adenoma were identified from 29 articles published from 1980 through 2011. In 38 patients (73%), CSF rhinorrhea developed following initiation of medical therapy, whereas spontaneous CSF leakage developed as the presenting symptom in 14 patients (27%). The patients' mean age was 42.8 years (range 23–68 years). There were 35 males and 17 females. Forty-two patients (81%) had a prolactinoma, with the remaining patients having the following tumors: nonfunctioning pituitary adenoma (6 patients), growth hormone–secreting adenoma (2 patients), mammosomatotroph cell adenoma (1 patient), and ACTH-secreting adenoma (1 patient). Infrasellar tumor invasion into the paranasal sinuses was specifically reported in 56% of patients. The medical agents associated with CSF leakage were dopamine agonists (97%) and somatostatin analogs (3%). The average time from initialization of medical treatment to onset of rhinorrhea was 3.3 months (range 3 days–17 months). Nonsurgical management was successful in 4 patients, including 1 who had successful resolution with a temporary lumbar drain. Forty-six patients (88%) underwent surgical intervention to treat the CSF leak and/or resect the tumor. In 2 patients, surgery was not performed due to medical contraindications or patient preference. Conclusions Nonsurgical development of CSF rhinorrhea may occur in the setting of pituitary adenomas, especially following favorable response of invasive prolactinomas to initiation of dopamine agonist therapy. Additional cases have been reported as the presenting symptom of a pituitary adenoma and are likely to be related to decreased tumor volume due to intrinsic infarction or hemorrhage, ongoing invasion, and/or increases in intracranial pressure. Surgical repair, preferentially via a transsphenoidal approach, is the recommended initial treatment for definitive repair of the CSF leak and achievement of maximal tumor resection.

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“…Dopamine agonists are associated with a good response of the tumors, despite their large dimensions, and are therefore recommended as first-line treatment for both prolactin level reduction and tumor shrinkage [3,4,6]. Surgical debulking may serve as a complementary method in individual patients to prevent the generally rare complications of medical treatment, such as pituitary apoplexy, CSF leakage, and chiasmal herniation [9], or as a second-line treatment in patients who are unresponsive to medical therapy. Surgery for giant pituitary adenomas may be associated with high mortality and morbidity (including diabetes insipidus, mental deterioration, visual loss, and CSF leaks), especially when performed through a craniotomy [10,11].…”

Section: Discussionmentioning

confidence: 99%

Unusual clinical presentations of giant prolactinomas

Grozinsky‐Glasberg

Shimon

2008

Pituitary

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Giant prolactinomas are rare pituitary tumors which have scarcely been reported in the literature. We describe three men with unusual presenting features of prolactin-secreting giant pituitary adenomas: prolonged and increasingly disturbing intolerance to light and noise; strange behavior and mood disturbances; and rhinorrhea followed by a finding of cerebrospinal fluid leakage. Treatment with dopamine agonist alleviated all symptoms, with concomitant suppression of plasma prolactin levels and a significant reduction in tumor mass. These cases emphasize the importance of considering unusual symptoms in the differential diagnosis of giant prolactinomas and the effectiveness of medical treatment.

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CSF rhinorrhoea following treatment with dopamine agonists for massive invasive prolactinomas

Cited by 92 publications

References 34 publications

Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men

Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men

Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature

Unusual clinical presentations of giant prolactinomas

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