Brain & chiasmal herniations into sella after medical treatment of prolactinoma.
BACKGROUND
Dopamine agonists are widely used in the treatment of pituitary prolactinomas. We report a case of inferior mesial frontal lobe (gyrus rectus) and chiasmal herniations into an enlarged sella following successful medical treatment of a pituitary macroadenoma.


METHODS
A 71-year-old healthy man presented to medical attention with visual complaints. On examination, he was found to have bitemporal hemianopsia. Endocrine evaluation revealed an elevated prolactin level. He was treated medically with a dopamine agonist (bromocriptine).


RESULTS
Evaluation after one year of medical treatment revealed stabilization of the patient's vision, with a significant bitemporal field loss. Serum prolactin levels normalized (5.16 ng/ml). The MRI of the sella showed almost complete disappearance of the tumor, resulting in right mesial frontal lobe herniation inferiorly into an enlarged sella with associated chiasmal deformation.


CONCLUSIONS
We report a case where successful medical treatment of a large pituitary prolactinoma has resulted in inferior frontal lobe and chiasmal herniatons into an enlarged sella.
Bangash
M H
MH
Department of Surgery (Neurosurgery), Dalhousie University, Halifax, Nova Scotia, Canada.
Clarke
D B
DB
Holness
R O
RO
D000368:Aged; D001971:Bromocriptine / Q000627:therapeutic use; D004677:Encephalocele / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005625:Frontal Lobe / Q000293:injuries / Q000473:pathology; D006423:Hemianopsia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D009897:Optic Chiasm / Q000293:injuries / Q000473:pathology; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011388:Prolactin / Q000037:antagonists & inhibitors / Q000097:blood; D015175:Prolactinoma / Q000601:surgery*; D012658:Sella Turcica / Q000473:pathology* / Q000601:surgery
D006727:Hormone Antagonists; D001971:Bromocriptine; D011388:Prolactin