Pons herniation into skull base after cabergoline therapy of giant prolactinoma

Herbera, Jesús Moles; Celada, David Rivero; Gañán, I. Montejo; Miguel, David Fustero de; Uliaque, Carlos Fuentes; Marín, Ana Carmen Vela

doi:10.1007/s11102-014-0558-9

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…On the basis of his clinical course, we concluded that the rapid reduction of the tumor by DA therapy, resulting in retraction of brain matter, especially the temporal lobe around the tumor, could have been the mechanism of the epileptic seizures. This mechanism is a known cause of brain herniation with DA therapy for giant PRLomas [8, 9, 11]. The appearance of a hyperintense area in left frontal lobe on T2-weighted images may support our hypothesis of the pathogenic mechanisms of the epileptic seizure in our patient.…”

Section: Discussionsupporting

confidence: 77%

“…Moles Herbera et al . reported a giant PRLoma showing pons herniation into the skull base caused by tumor shrinkage after DA therapy [11]. In addition, some authors reported cases of frontal lobe herniation as a rare complication of DA therapy (Table 2) [8–10, 12].…”

Section: Discussionmentioning

confidence: 99%

“…(2009) [10]64 /M17851.0Optic chiasmaVisual field loss30 /M6603.057 /M4823.0Herbera et al . (2015) [11]59 /M11081.0PonsDysarthria, a left hemiplegia Abbreviations: CAB Cabergoline, DA Dopamine agonist, PRL Prolactin…”

Section: Discussionmentioning

confidence: 99%

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Status epilepticus induced by treatment with dopamine agonist therapy for giant prolactinoma: a case report

et al. 2019

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BackgroundDopamine agonists are the standard first-line medical therapy for prolactinoma. We report a rare case of giant prolactinoma with a first epileptic seizure due to rapid reduction of the tumor as a complication of dopamine agonist therapy.Case presentationA 27-year-old Japanese man presented to our institution with a history of visual disturbance for 1 year and general fatigue for 3 months. Magnetic resonance imaging showed a tumor that arose from the pituitary and extended to the bilateral anterior skull base, the clivus, and the cavernous sinus, with compression of the optic chiasm and the bilateral frontal and temporal lobes. On the basis of the patient’s serum concentration of prolactin, we diagnosed a prolactinoma and started dopamine agonist therapy with cabergoline. The patient had a general seizure immediately after starting dopamine agonist therapy and required general anesthetic treatment following the rapid reduction of the tumor. We speculated that the rapid reduction of the tumor resulted in the retraction of the surrounding brain structure, and the epileptic seizure was then induced by dopamine agonist therapy.ConclusionsWe report a rare case of giant prolactinoma with a first epileptic seizure immediately after the initiation of dopamine agonist therapy. Clinicians need to be aware that the rapid reduction of a giant prolactinoma by dopamine agonist therapy may cause an epileptic seizure.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Status epilepticus induced by treatment with dopamine agonist therapy for giant prolactinoma: a case report

et al. 2019

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“…Recently, a case of pons herniation into the clivus after treatment of a giant prolactinoma with cabergoline has been reported. Moles Herbera et al ( 28 ) reported a 59-year-old with a giant prolactinoma treated with cabergoline 1 mg per week. Eighteen months after treatment he presented with left hemiparesis and dysarthria.…”

Section: Discussionmentioning

confidence: 99%

Brain and Optic Chiasm Herniation into Sella after Pituitary Tumor Apoplexy

et al. 2017

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Brain and optic chiasm herniation has been rarely reported following dopamine agonist treatment for large prolactinomas. We report a case of brain and optical chiasm herniation, secondary to an empty sella due to apoplexy of a prolactinoma, and we focus on the specific presentation of this case. A 32-year-old female presented to a neurologist complaining of headaches. Her past medical history was significant for acute vision loss in both eyes accompanied by right third nerve palsy when she was 16 years old. She does not recall any endocrine or imaging evaluation at that time and she had spontaneous partial recovery of left eye vision within 3 months, with permanent blindness of right eye. She did not return to any follow-up until her neurologist consultation. Brain magnetic resonance imaging (MRI) revealed herniation of frontal lobe and optic chiasm into the pituitary sella, as well as a pituitary hypointense lesion measuring 5 mm × 5 mm after gadolinium injection. Prolactin levels were 206 ng/ml (4.79–23.3 ng/ml). Repeated prolactin was 258 ng/ml (4.79–23.3 ng/ml). She was started on bromocriptine 2.5 mg/day. Prolactin levels and menstrual cycles normalized. A repeat brain MRI performed 5 months later showed disappearance of pituitary mass, with no changes in brain and chiasmal herniation. To our knowledge, this is the first reported case of brain associated with chiasm herniation secondary to pituitary apoplexy of a prolactinoma. In conclusion, this case highlights that frontal lobe herniation in combination with optic chiasm herniation can be a complication of pituitary tumor apoplexy. Long-term surveillance of patients with pituitary apoplexy is warranted to detect delayed complications.

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Cabergoline

2015

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Pons herniation into skull base after cabergoline therapy of giant prolactinoma

Abstract: Some studies have shown that a significant and rapid tumor shrinkage resulting from treatment with cabergoline can occur and it is thought that some complications are related with this tumor regression, as in the presented case.

Cited by 3 publications

References 12 publications

Status epilepticus induced by treatment with dopamine agonist therapy for giant prolactinoma: a case report

Status epilepticus induced by treatment with dopamine agonist therapy for giant prolactinoma: a case report

Brain and Optic Chiasm Herniation into Sella after Pituitary Tumor Apoplexy

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