Determinants of cerebrospinal fluid leakage in a large cohort of macroprolactinomas

Abstract

Introduction

Macroprolactinomas are the most frequent subtype of pituitary adenomas. Their treatment has been improved since the onset of dopamin agonists (DA). Nevertheless, DA can cause a cerebospinal fluid (CSF) leakage by shrinking the tumor and lead to a bacterial meningitis. This complication might have lethal consequences.

Methods

We conducted an observational, retrospective study in the Pituitary Unit in Pitié Salpêtrière Hospital. A total of 171 patients with macroprolactinomas (larger diameter greater than 10mm) were included in the study. We compared patients who presented cerebrospinal rhinorrhea and/or meningitis, so-called complicated patients (C group), to patients who presented no complications during their follow-up, so-called uncomplicated patients (UC group): no occurrence of rhinorrhea, meningitis.

Results

Cerebrospinal fluid (CSF) leakage has been found in 5% of patients in our large cohort of macroprolactinoma. Determinants of CSF leakage seems to be : adenoma size with concomitant supra- and infrasellar extension, very high prolactin level (> 1000µg/l), cabergoline treatment.

Conclusion

 Cerebrospinal rhinorrhea is a rare complication of macroprolactinomas, but potentially lethal because of meningitis risk. Anti-pneumococcal and anti-haemophilus vaccination appears to be appropriate in these patients at the time of introduction of DA, to prevent meningitis.