Is surgical intervention frequently required for medically managed macroprolactinomas? A study of spontaneous cerebrospinal fluid rhinorrhea.
BACKGROUND
The frequency of spontaneous CSF rhinorrhea in macroprolactinoma patients is poorly documented and was previously thought to be a very rare occurrence.


METHODS
Thirty patients with macroprolactinomas (>1.0 cm diameter) identified from the Swansea neuroendocrine database were studied retrospectively.


RESULTS
At presentation, the median serum prolactin was 28,354 (range, 1844 to >6,000,000) mU/L; radiologically, 4 adenomas were invading the cavernous sinus, one the sphenoid sinus and 5 both the cavernous and sphenoid sinus. After commencement of medical therapy, 4 subjects developed CSF rhinorrhea requiring surgical correction; all 4 had tumors invading both the cavernous and sphenoid sinus and an initial serum prolactin more than 75,000 mU/L. One subject developed an acute psychosis, and a man who presented with delayed puberty committed a serious sexual offense.


CONCLUSIONS
Serious adverse effects are not uncommon in medically treated macroprolactinoma patients. Subjects with adenomas invading the sphenoid sinus have a high risk of developing CSF rhinorrhea that requires neurosurgical intervention.
de Lacy
Patricia
P
Department of Neurosurgery, Morriston Hospital, Swansea, UK. pdelacy44@hotmail.com
Benjamin
Silas
S
Dixon
Rebecca
R
Stephens
Jeffrey W
JW
Redfern
Robert
R
Price
David E
DE
D000328:Adult; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000473:pathology; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D002985:Clinical Protocols; D003399:Craniotomy / Q000379:methods / Q000592:standards; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000473:pathology / Q000601:surgery; D009361:Neoplasm Invasiveness / Q000473:pathology / Q000503:physiopathology; D019635:Neurosurgical Procedures / Q000592:standards; D010902:Pituitary Gland / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D011388:Prolactin / Q000032:analysis / Q000097:blood / Q000378:metabolism; D015175:Prolactinoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D013100:Sphenoid Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D011388:Prolactin