title: Spontaneous cerebrospinal fluid rhinorrhea in untreated macroprolactinoma--an indication for primary surgical therapy.
abstract: BACKGROUND
  Medical therapy is usually indicated as first-line treatment for prolactinomas. Surgery is generally reserved as second-line therapy if prolactinomas are non-responsive to dopamine agonists (DA) or DA therapy is not tolerated. Herein, we draw attention to the rare occurrence of spontaneous CSF rhinorrhea in prolactinomas requiring primary surgical therapy. Only 8 cases of confirmed prolactinomas with spontaneous rhinorrhea have been reported in the literature so far.
  
  
  METHODS
  Two out of 267 surgical cases with pituitary adenomas presented with spontaneous rhinorrhea. Both patients harbored invasive prolactinomas. In both cases, the defect was exposed using a transsphenoidal procedure and was sealed with fascia lata.
  
  
  RESULTS
  Urgent surgical repair of the leak prevented meningitis. In one case, a second operation was required due to recurrent rhinorrhea under postoperative dopamine-agonist therapy of the residual tumor. The clinical course was otherwise uncomplicated.
  
  
  CONCLUSIONS
  Certain clinical settings still require primary surgical therapy of prolactinomas. Spontaneous rhinorrhea caused by invasive macroprolactinomas represents a mandatory indication for initial surgery. Early detection and surgical repair of a CSF leak is crucial for a favorable clinical outcome.
authors.affiliation: Klinik für Neurochirurgie, Universitätsklinik Tübingen, Germany. juergen.honegger@med.uni-tuebingen.de
authors.forename: J B
authors.initials: JB
authors.lastname: Honegger
authors.forename: T
authors.initials: T
authors.lastname: Psaras
authors.forename: M
authors.initials: M
authors.lastname: Petrick
authors.forename: F
authors.initials: F
authors.lastname: Beuschlein
authors.forename: M
authors.initials: M
authors.lastname: Reincke
mesh_terms: D000328:Adult; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D006728:Hormones / Q000097:blood; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D010911:Pituitary Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D015175:Prolactinoma / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D006728:Hormones