Spontaneous cerebrospinal fluid rhinorrhoea as the presenting feature of an invasive macroprolactinoma
- Satveer Kaur Mankia1,
- Ruwan Alwis Weerakkody2,
- Shanelle Wijesuriya3,
- Narayanan Kandasamy4,
- Francis Finucane4,
- Mathew Guilfoyle2,
- Nagui Antoun5,
- John Pickard2,
- Mark Gurnell4
- 1Department of General Medicine, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
- 2Department of Neurosurgery, Box 166, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
- 3School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
- 4Department of Endocrinology, Institute of Metabolic Science, Box 289, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
- 5Department of Neuroradiology, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
- Mark Gurnell, mg299{at}mole.bio.cam.ac.uk
- Published 21 May 2009
Summary
A 29-year-old male university student, with no prior history of trauma, presented with a 1 year history of clear fluid leaking intermittently from his left nostril. His past medical history included bilateral gynaecomastia since age 12, and recent low libido. β2-transferrin analysis of the nasal fluid confirmed a diagnosis of cerebrospinal fluid (CSF) rhinorrhoea. The serum prolactin was grossly elevated at 42 700 mU/l and brain magnetic resonance imaging (MRI) revealed a large parasellar/sellar mass. A diagnosis of invasive macroprolactinoma complicated by spontaneous CSF rhinorrhoea was made. The patient was commenced on treatment with cabergoline, but while awaiting surgery to repair the CSF leak he developed streptococcus mitis and sanguis meningitis. He made an uncomplicated recovery with antibiotic treatment. Immediately following this episode, the CSF rhinorrhoea resolved spontaneously. Subsequently, a repeat MRI scan revealed dramatic involution of the pituitary mass and the serum prolactin had fallen to 604 mU/l.
Footnotes
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Competing interests: none.
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Patient consent: Patient/guardian consent was obtained for publication
