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<p>Cerebrospinal fluid (CSF) rhinorrhea is a rare and unexpected initial presentation of untreated invasive pituitary macroprolactinoma. This article aims to better understand the management of invasive pituitary macroprolactinoma, especially in cases where the patient initially presents with a CSF leak. We describe a case of a 36-year-old male with untreated invasive macroprolactinoma with a CSF leak at the initial presentation. The role and timing of medical and surgical treatment in such a setting are outlined in detail. Medical therapy has shown both worsening and resolution of the CSF leak. We propose a ‘’Sandwich Therapy’’ in Dopamine agonist (DA) responsive cases where the leak persists, which includes initial DA therapy, followed by endoscopic Transsphenoidal surgery (TSS) with DA therapy and then followed by the post-operative continuation of DA therapy.</p>

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Invasive Pituitary Macroprolactinoma with Spontaneous CSF Rhinorrhea- A Case Report with a Review of the Literature and a Strategical Plan of Management

  • 期刊论文

  • 发表日期：

    2025年3月6日

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  • Palak Gupta,
  • Neha Shakrawal,
  • Vidhu Sharma,
  • Ravindra Shukla,
  • Mayank Garg,
  • Darwin Kaushal,
  • Amit Goyal

摘要

Cerebrospinal fluid (CSF) rhinorrhea is a rare and unexpected initial presentation of untreated invasive pituitary macroprolactinoma. This article aims to better understand the management of invasive pituitary macroprolactinoma, especially in cases where the patient initially presents with a CSF leak. We describe a case of a 36-year-old male with untreated invasive macroprolactinoma with a CSF leak at the initial presentation. The role and timing of medical and surgical treatment in such a setting are outlined in detail. Medical therapy has shown both worsening and resolution of the CSF leak. We propose a ‘’Sandwich Therapy’’ in Dopamine agonist (DA) responsive cases where the leak persists, which includes initial DA therapy, followed by endoscopic Transsphenoidal surgery (TSS) with DA therapy and then followed by the post-operative continuation of DA therapy.