Cabergoline-induced cerebral spinal fluid leak in a patient with a large prolactinoma and MEN1

Abstract: Cerebral spinal fluid (CSF) rhinorrhea immediately after the initiation of cabergoline in prolactinoma patients is an uncommon complication that could lead to serious comorbidities and management difficulties. We present a case of a woman with multiple endocrine neoplasia type 1 syndrome and a recurrent macroprolactinoma, who developed CSF rhinorrhea and pneumocephalus after 3 doses of 0.5 mg cabergoline. The patient was treated for sinusitis after complaining of increasing headache. Imaging revealed a large pituitary tumor, skull base erosion, and pneumocephalus. Skull-base defect repair and subsequent transsphenoidal tumor debulking was performed. Prolactin continued to increase postoperatively, and the dopamine agonist (DA) was changed to bromocriptine, with no further CSF leak during 18 months of follow-up. We recommend urgent surgical repair as the treatment of choice for CSF leak following DA treatment. Concurrent surgical tumor debulking should be preformed if possible. Retreatment with DA is a safe option in most cases. To our knowledge, CSF rhinorrhea following cabergoline therapy has not been described in the multiple endocrine neoplasia type 1 syndrome.