Pneumocephalus and Cerebrospinal Fluid Rhinorrhea after Bromocriptine Therapy of an Invasive Prolactinoma

Abstract

It is exceedingly rare to observe the complications of cerebral spinal fluid (CSF) rhinorrhea and pneumocephalus after initiating bromocriptine therapy of prolactinomas that have not previously undergone surgical or radiotherapy treatment. We describe a patient with a 25-year history 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 bromocriptine therapy. This is the first patient reported with both CSF rhinorrhea and pneumocephalus after only bromocriptine therapy. Review of the literature revealed that all reported cases of bromocriptine-induced rhinorrhea were associated with sellar erosion and required surgical repair or CSF shunt placement to halt the CSF leak. The significant risk of morbidity and mortality from CSF rhinorrhea pneumocephalus, and meningitis makes it necessary to consider these complications during bromocriptine therapy of patients with invasive prolactinomas.