Untreated Giant Macroprolactinoma with Chronic Cerebrospinal Fluid Leakage: An Unusual Complication
Macroprolactinoma has the potential to cause base of skull erosion and often extends into the sphenoid sinus. Rapid shrinkage of this invasive tumor following dopamine agonist therapy has been postulated to cause unplugging of the eroded area, leading to cerebrospinal fluid leakage. To the best of o...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2019/4825357 |
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| author | Mohamad Nazrulhisham Mad Naser Nor Azizah Aziz Noor Khairiah A. Karim |
| author_facet | Mohamad Nazrulhisham Mad Naser Nor Azizah Aziz Noor Khairiah A. Karim |
| author_sort | Mohamad Nazrulhisham Mad Naser |
| collection | DOAJ |
| description | Macroprolactinoma has the potential to cause base of skull erosion and often extends into the sphenoid sinus. Rapid shrinkage of this invasive tumor following dopamine agonist therapy has been postulated to cause unplugging of the eroded area, leading to cerebrospinal fluid leakage. To the best of our knowledge, the occurrence of spontaneous cerebrospinal fluid leak in treatment-naive prolactinomas is very rare, the majority of which involve undiagnosed macroprolactinomas. We describe here a lady presented late with giant macroprolactinoma, complicated by cerebrospinal fluid leakage. This case raised the dilemma in the management pertaining to the role of either pharmacotherapy or surgical intervention, or combination of both. As she strictly refused surgery, she was treated with bromocriptine which was later changed to cabergoline. On follow-up, there was cessation of cerebrospinal fluid leak, marked reduction of serum prolactin level, and imaging evidence of tumor shrinkage. The majority of patients with medically induced cerebrospinal fluid leakage will require surgical procedures to overcome this complication; however, there are isolated cases of leakage resolution on continuing dopamine agonist therapy while awaiting surgery. The use of dopamine agonist does not necessarily cause worsening of cerebrospinal fluid leakage and instead may produce spontaneous resolution as in this case. |
| format | Article |
| id | doaj-art-6587c2bf4f7b4b77a7d27b9e5736e11b |
| institution | Kabale University |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-6587c2bf4f7b4b77a7d27b9e5736e11b2025-08-20T03:34:17ZengWileyCase Reports in Endocrinology2090-65012090-651X2019-01-01201910.1155/2019/48253574825357Untreated Giant Macroprolactinoma with Chronic Cerebrospinal Fluid Leakage: An Unusual ComplicationMohamad Nazrulhisham Mad Naser0Nor Azizah Aziz1Noor Khairiah A. Karim2Department of Medicine, Hospital Pulau Pinang, Jalan Residensi, 10990 Georgetown, Pulau Pinang, MalaysiaEndocrinology Unit, Department of Medicine, Hospital Pulau Pinang, Jalan Residensi, 10990 Georgetown, Pulau Pinang, MalaysiaRegenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, 13200 Kepala Batas, Pulau Pinang, MalaysiaMacroprolactinoma has the potential to cause base of skull erosion and often extends into the sphenoid sinus. Rapid shrinkage of this invasive tumor following dopamine agonist therapy has been postulated to cause unplugging of the eroded area, leading to cerebrospinal fluid leakage. To the best of our knowledge, the occurrence of spontaneous cerebrospinal fluid leak in treatment-naive prolactinomas is very rare, the majority of which involve undiagnosed macroprolactinomas. We describe here a lady presented late with giant macroprolactinoma, complicated by cerebrospinal fluid leakage. This case raised the dilemma in the management pertaining to the role of either pharmacotherapy or surgical intervention, or combination of both. As she strictly refused surgery, she was treated with bromocriptine which was later changed to cabergoline. On follow-up, there was cessation of cerebrospinal fluid leak, marked reduction of serum prolactin level, and imaging evidence of tumor shrinkage. The majority of patients with medically induced cerebrospinal fluid leakage will require surgical procedures to overcome this complication; however, there are isolated cases of leakage resolution on continuing dopamine agonist therapy while awaiting surgery. The use of dopamine agonist does not necessarily cause worsening of cerebrospinal fluid leakage and instead may produce spontaneous resolution as in this case.http://dx.doi.org/10.1155/2019/4825357 |
| spellingShingle | Mohamad Nazrulhisham Mad Naser Nor Azizah Aziz Noor Khairiah A. Karim Untreated Giant Macroprolactinoma with Chronic Cerebrospinal Fluid Leakage: An Unusual Complication Case Reports in Endocrinology |
| title | Untreated Giant Macroprolactinoma with Chronic Cerebrospinal Fluid Leakage: An Unusual Complication |
| title_full | Untreated Giant Macroprolactinoma with Chronic Cerebrospinal Fluid Leakage: An Unusual Complication |
| title_fullStr | Untreated Giant Macroprolactinoma with Chronic Cerebrospinal Fluid Leakage: An Unusual Complication |
| title_full_unstemmed | Untreated Giant Macroprolactinoma with Chronic Cerebrospinal Fluid Leakage: An Unusual Complication |
| title_short | Untreated Giant Macroprolactinoma with Chronic Cerebrospinal Fluid Leakage: An Unusual Complication |
| title_sort | untreated giant macroprolactinoma with chronic cerebrospinal fluid leakage an unusual complication |
| url | http://dx.doi.org/10.1155/2019/4825357 |
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