PNEUMOCEPHALUS AND CEREBROSPINAL-FLUID RHINORRHEA AFTER BROMOCRIPTINETHERAPY OF AN INVASIVE PROLACTINOMA - A CASE-REPORT AND REVIEW OF THELITERATURE

It is exceedingly rare to observe the complications of cerebral spinal fluid (CSF) rhinorrhea and pneumocephalus after initiating bromocript ine therapy of prolactinomas that have not previously undergone surgic al or radiotherapy treatment. We describe a patient with a 25-year his tory of an untreated invasive prolactinoma who responded dramatically to bromocriptine therapy with a reduction in the size of the tumor and normalization of prolactin levels. Her course was complicated by CSF rhinorrhea after 6 days and pneumocephalus after 29 days of bromocript ine therapy. This is the first patient reported with both CSF rhinorrh ea and pneumocephalus after only bromocriptine therapy. Review of the literature revealed that all reported cases of bromocriptine induced r hinorrhea were associated with sellar erosion and required surgical re pair or CSF shunt placement to halt the CSF leak. The significant risk of morbidity and mortality from CSF rhinorrhea, pneumocephalus, and m eningitis makes it necessary to consider these complications during br omocriptine therapy of patients with invasive prolactinomas.