Cabergoline-induced CSF rhinorrhea in patients with macroprolactinoma. Report of three cases

Three cases of cerebrospinal fluid (CSF) leak, in subjects with an invasive macroprolactinoma under treatment with cabergoline (CAB), are reported. Th e patients underwent surgical treatment by means of an endoscopic endonasal transsphenoidal approach, which allowed removal of the lesion and sealing of the fistula. Many cases of CSF rhinorrhea are described in literature af ter bromocriptine therapy in invasive prolactinomas, but only one report ha s been recently published of such condition after CAB treatment. The compli cation is likely due to the brisk cessation of the so-called "stopper effec t", i.e. the tumor mechanically blocking the CSF leak in spite of its previ ous erosion of the skull-base, when CAB induces the macroprolactinoma shrin kage. Endoscopic transsphenoidal surgery offers a safe, minimally invasive and efficient management of this complication, which allows to regularly pe rform the following steps of the therapeutical strategy against the prolact inoma.