Cystic Degeneration of Macroprolactinoma on Long-Term Cabergoline

This is the authors' abstract. We don't add key points for this paper.

A 42-yr-old man presented with fever, headache, and vomiting and reported clear fluid dripping from the nose for 2 months preceding the admission. Imaging demonstrated a large tumor eroding the skull base (Figs. 1 and 22). Prolactin was elevated at 92,000 mIU/liter (normal range 53–360). Cerebrospinal fluid (CSF) culture was negative, but Streptococcus species was grown from blood cultures. After treatment for bacterial meningitis, CSF fistula was surgically repaired. Subsequent pituitary testing was diagnostic of testosterone, cortisol, and GH deficiencies. The patient was discharged on cabergoline 0.5 mg weekly and hydrocortisone replacement. Three and a half years after the presentation, he remains well on testosterone and steroid replacement, and the tumor has undergone cystic degeneration (Fig. 3) on this dose of carbergoline. Pituitary tumors eroding the skull base and presenting with CSF fistula are rare (1). Nonetheless, most prolactinoma-related CSF fistulas were consequent to tumor shrinkage due to dopamine agonist treatment (1, 2). In a series of giant invasive prolactinomas, mortality due to CSF fistula was 10% or possibly even 20% (3). The aim of treating invasive prolactinomas is normalizing prolactin levels and preserving the anatomical integrity of the skull base. Dopamine agonist therapy may lead to tumor size reduction of up to 80% in the majority of cases (4). Radiotherapy carries a risk of damage to the surrounding structures. In patients with tumors sensitive to dopamine agonist treatment, low-dose cabergoline may achieve these aims. High-resolution computed tomography of the skull shows bone destruction by the pituitary tumor. Pituitary magnetic resonance imaging, coronal section, after Gadolinium enhancement, shows pituitary tumor. Pituitary magnetic resonance imaging, coronal section, after Gadolinium enhancement, shows cystic degeneration of the tumor after treatment. Disclosure Summary: The authors have nothing to declare. Cerebrospinal fluid.