Endocrine Abstracts

We present a rare case of Graves’ disease accompanied by pheochromocytoma, which showed normal urine and serum levels of catecholamines and their metabolites. A 45-year-old woman was referred to our hospital for the evaluation of a right adrenal incidentaloma detected by computed tomography. She was diagnosed with Graves disease at 6 months ago. Initially she got an antithyroid medication include methimazole, but her thyroid function could not control easily. So, radioact...

Antithyroid drugs frequently used in management of hyperthyroidism may lead to liver damage. Hepatotoxicity is a rare but potentially fatal complication. The aim of this study was to present two cases of severe liver damage and the role of 131-I treatment in such cases.Case 1: A women 49 years of age with Graves hyperthyroidism was treated with metimazol (30 mg next 10 mg). After 1 month the utricarial skin rush was observed and the drug was changed to P...

Lymphocytic hypophysitis (LH), an uncommon pituitary disorder that is considered an autoimmune disease. The disease shows a striking female predilection of ~9:1 and commonly affects young women during late pregnancy or in the postpartum period. Less frequently, it has also been observed in men and postmenaposal woman. Partial or total hypopituitarism can be in LH. In the early stage, the pituitary gland is enlarged like a pituitary tumor, from which it cannot be distinguished ...

We report an 18 years old female with hepatomegaly and elevated liver function tests. She had been diagnosed with Type 1 diabetes mellitus when she was 13 years old. She was referred to our division because of diabetic ketoacidosis. Evaluation of her previous records revealed the presence of liver function abnormalities for 4 months. At physical examination she had an enlarged liver. A1c level was 13%. She was treated initially with intravenous insulin. Following the achieveme...

Introduction: The incidence, cell origin, histopathologic features and prognosis of papillary and medullary carcinoma are considered to be completely different. Simultaneous occurrence of medullary and papillary thyroid carcinoma in the same patient is rare. Here, we present a patient with synchronous medullary thyroid carcinoma and papillary microcarcinoma occurring in a thyroid with chronic lymphocytic thyroiditis.Case: A 47 years old woman with no his...

Introduction: The mammary cancer is the most frequent malign tumor encountered in females, characterized by a high distant metastasis tendency. Among the potential prognosis factors, we mention the biomarkers that measure or are associated with biologic processes involved in the tumorous progression. The study analyzes the p53 protein’s positivity in correlation with the mammary cancer’s classical prognosis factors: the hystologic type, the histopathologic degree, th...

Many causes of levothyroxine malabsorption have been described in the literature such as celiac disease, giardiasis, severe liver cirrhosis and drug interactions. A 27-year-old woman admitted to our institution with overt hypothyroidism symptoms. She had total thyroidectomy for thyroid papiller carcinoma and was using 400 μg/day levothyroxine (LT4). Her serum free thyroxine (fT4), free triiodothyronine (fT3) and thyrotropin stimulating hor...

Six years after hemorrhagic fever with renal syndrome (HFRS) 73 years old man was admitted in hospital because of hyponatremia (Na 129 mmol/l) and abdominal pain. Before HFRS he was treated for pancreatitis, hypertension, ulcerative colitis and gallstones. In the year 2002 he was admitted with fiver, vomiting, diarrhoea, headache and blurred vision. Serologic immunoflourescence testing was positive for Hantaan (Puumala) virus. During the hospital course haemodialysis was neces...

Background: Paget’s disease may affect as many as 3% of adults older than 40 years of age; it is often asymptomatic and usually progresses slowly. Paget’s disease affects men and women almost equally, but men tend to be more symptomatic. The disease is usually not clinically apparent until age 50–60 years. It usually progresses slowly and does not develop in new sites. Many different bones can be affected, and the lesions can vary from single, monostotic lesions...

Seckel syndrome (SS) is described as the prototype of the primordial bird-headed type of dwarfism (Seckel 1960). It represents a spectrum of multisystem abnormalities. We present a case of SS and discuss the possible effects of IGF-1 and IGF-3 in the development of growth failure, type 2 Diabetes Mellitus (DM) and severe insulin resistance (IR).Case: A 21-year-old female was referred to our clinic because of growth retardation and amenorrhea. At birth, s...

Aim: To present a case of severe primary hyperparathyroidism (PHPT) manifested predominantly with polyuria.Case: A 53 years old caucasian female presented to the emergency room with polyuria (5-6 l), and increasing during last 4 weeks dehydration, weight loss (10 kg), weakness, confusion. Diabetes mellitus and insipidus had been excluded. After hypercalcemia (3.6–3.9 mmol\l), Ca++ to 2.0 mmol\l and PTH of 616 pg\ml (11–62) were revealed acute P...

Iatrogenic Cushing syndrome caused by the use of steroid medications is common because of the widespread use of these medications for the treatment of many diseases, however development of Cushing syndrome from the topical corticosteroids is very rare in adults.A 45-year-old men (BMI: 44 kg/m2), with a history of psoriasis, developed manifestations of Cushing syndrome, which included weight gain, central obesity, moon face, facial plethora, bu...

Congenital adrenal hyperplasia (CAH) owing to 21 hydroxylase deficiency (21OHD) is an inherited autosomal disorder characterized by diminished glucocorticoid and aldosteron biosynthesis. Partial 21OHD leads to the classical simple virilizing form, characterized by prenatal virilization of external genitalia in female fetuses without salt wasting. Ambiguous genitalia in a genetically female infant is frequently due to CAH. The uncertainty about the sex of a newborn is often inc...

In new classification of autoimmune polyendocrine syndromes (APS), APS-3 has defined as combination of autoimmune thyroid disease and other autoimmune disease except hypoparathyroidism and Addison’s disease. The present report describes a patient with APS-3 and pseudomalapsorbtion of levothyroxine (LT4). Twenty-three year old woman was referred to our center with hypothyroidism due to Hashimoto’s thyroiditis (HT) despite the usage of high dose LT4 treatment. HT was d...

Introduction: Amiodarone-induced thyrotoxicosis(AIT) is a condition fraught with difficulties from the diagnostic and therapeutic standpoints. It can be developed precociously or years after the beginning amiodarone uptake and after its suspension. AIT is subdivided in three different forms. Type 1 is developed in subjects with underlying thyroid disease, being caused by an exacerbation by iodine load of thyroid autonomous function. Type 2 is a form of destructive thyroiditis ...

Introduction: Medullary thyroid carcinoma (MTC) commonly metastasizes to cervical lymph nodes, liver, lungs and bone. Metastatic lesions in the breast have been previously reported but they are extremely rare and to our knowledge, this is the first case in literature described on a male patient. We report a case of a 49-year-old man with a 23-year history of sporadic MTC with bone, liver and lung metastases treated with somatostatin analogues for 6 years, who developed a painf...

Introduction: Islet hyperplasia and nesidioblastosis are described in the non neoplastic pancreas of patients with gastrinoma. It is not definately established whether hypergastrinemia can influence these changes. Moreover, rarely insulinoma and gastrinoma occur in the same patient but cases of single tumours cosecreting both insulin and gastrin have been described. Otherwise, the syndrome of hyperinsulinemic hypoglycaemia with nesidioblastosis after Roux-en-Y gastric bypass h...

A 27 year-old-man was admitted to our hospital with pain in the back. Bone mineral density evaluation revealed severe osteoporosis at L1–L4 vertebrae, as well as on femur, too. Secondary osteoporosis reasons like thyrotoxicosis, glucocorticoid therapy, hypercortisolemia, hypercalciuria, hyperparathyroidism were excluded. Laboratory examination of the patient revealed to a hypoglobulinemia. Further evaluation of the immunoglobulin levels were in concordance with panhypoglo...

Medullary thyroid carcinoma is an uncommon malignancy of hereditary and sporadic presentation. Mutations in the RET-protooncogene are involved in the pathogenesis of >50% of the sporadic cases. Currently, there is no effective treatment for metastatic medullary thyroid carcinoma. The aim was to present a case of metastatic medullary thyroid carcinoma that was treated by the administration of sorafenib, a multiple kinase inhibitor.A patient, female ag...

Introduction: The Gasser Ganglion is a large semi lunar-shaped ganglion of the trigeminal nerve. It contains the cells of origin of the most sensory fibers of the fifth cranial nerve.Aim: Our purpose is to describe a case where Gasser ganglion has an anatomic variant (near the sella turcica), mimicking a hypophyseal tumor.Case presentation: Of 17 years female patient has a history of bradispaniomenorrhea (menses at 30–50 days)...

A 52-year-old, previously well Indian lady was admitted in May 2008 with pneumonia. Concurrently, she was diagnosed with diabetes mellitus (blood glucose 20 mmol/l). Her BMI was 19 kg/m2 and she was initially commenced onto sulphonylurea therapy. She had a further admission in July 2008 with dizzy episodes, falls, postural hypotension (systolic postural drop 75 mmHg) and erratic blood glucose levels (range 1.1–30 mmol/l). Blood ketones were 3.6 mmol/l without a...

Background: Primary hyperparathyroidism (PHPT) is nowadays an asymptomatic disease characterized by mild hypercalcemia and elevated parathormone (PTH) levels. PHPT is caused by parathyroid adenoma in 80–85% of patiens, up to 20% are located ectopically and therefore an ultrasound investigation is not helpful. SPECT sestamibi or tetrofosmin scintigraphy of the neck and thorax is considered to be the optimal method for the evaluation of ectopic parathyroid adenoma.<p cl...

Background: Glucocorticoid resistance syndrome is a rare, familial or sporadic disease, caused by genetic mutations of the glucocorticoid receptor or at any other level of the signaling pathway. It is characterized by general, partial, target-tissue insensitivity to glucocorticoids, leading to activation of the hypothalamo–hypophysis–adrenal axis resulting in compensatory increased levels of cortisol, but also increased concentrations of adrenal products with mineral...

A reliable form of androgen substitution therapy in terms of favorable kinetics and tolerance as well as effective restoration of androgenicity is paramount in hypogonadal men. A feasible modality is the intramuscular injection of the long-acting ester testosterone undecanoate (TU).We report data from 183 patients (99 with primary, 70 with secondary hypogonadism and 14 with late-onset hypogonadism) aged 15–70 years (mean 37±12 years) receiving ...

Background and aims: Patients with AVPR2 gene mutations present nephrogenic diabetes insipidus (NDI) resulting to a severe deficit in urine concentration despite high levels of circulating Antidiuretic Hormone (ADH). The mutation in codon 106 of the AVPR2 gene leading to the substitution of arginine by cysteine (R106C) is known to produce a mild disease while in vitro characterization revealed a complete loss of function. We report the case of a 24-year-old male member ...

Background: Pituitary insufficiency is an uncommon endocrine disorder (incidence 2–4 per 100 000 per year), which clinical symptoms depend on the degree of hormone depletion and the rapidity of onset.Aim: To determine the clinical presentation, aetiology and clinical forms in 150 patients diagnosed with pituitary insufficiency.Material and methods: Retrospective study of clinical records of 150 patients with pituitary insuffic...

Occurrence of arterial hypertension (AH) in acromegaly (A) is the significant risk factor for sudden death. The study group included 232 patients with A aged 47–67 year (mean age 54). The duration of active phase of A was 7–17 years (median 11), GH levels were 23–19.2 ng/ml (mean 6.5), IGF-1 were 223–568 ng/ml (mean 354). AH was found in 186 patients (80.2%): 1st degree – 27%, 2nd – 32%, 3rd – 41%. Of 24-hour arterial blood pressure monitorin...

Muslims with diabetes are confronted with a dilemma during the annually fasting period: the Ramadan. The Islam foresees a delay of fasting for sick people, but Muslim patients with diabetes do not feel themselves as sick people. How they cope with it?Muslim diabetes patients are contacted in the outpatient department of three hospitals in Antwerp. Well educated students in diet education with a Muslim tradition, question the patients about their food con...

Background: Clinical practice guidelines on diabetes mellitus (DM) have been developed in 2006 by The Society of Endocrinology and Metabolism of Turkish (SEMT). The ongoing ADMIRE Project is designed to evaluate the effect of implementation of various activities to increase the awareness of physicians on the adherence to SEMT guidelines. The first phase results of the project is presented.Methods: Of 180 physicians evaluated previous 12 months’ medi...

Controversy remains as to the risk of cardiovascular disease (CHD) associated with subclinical hypothyroidism (SCH). Substantial evidence indicates altered cholesterol and lipoprotein metabolism in SCH when serum TSH is above 10 mUI/l. It is apparent that an enhanced CV risk could apply to these patients, amplified by the co-presence of other risk factors such as endothelial dysfunction and elevated C-reactive protein.We assessed the association between ...

This 52-year-old lady presented in 2001 at a GI clinic complaining of occasional abdominal cramps, which could be severe and prolonged. Her symptoms were not associated with diarrhoea or constipation. Weight loss of 4.5 kg over 4 months was noted. Coeliac disease was excluded and a diagnosis of severe irritable bowel was made.In January 2002 she returned to the clinic with further weight loss (total 8 kg), cyclical symptoms of diarrhoea lasting 3–5 ...

Background: The most common etiology of hypercalcemia is primary hyperparathyroidism (PHPT). PHPT is a disorder of calcium, phosphorus and bone metabolism secondary to uncontrolled increased parathyroid hormone secretion. PHPT has a variable clinical expression. Symptomatic PHPT is still the predominant form of the disease in many parts of the World, especially in developing countries.Methods: We summarized the clinical presentation, biochemical and radi...

Neuroendocrine tumours (NETs) are rare neoplasm arising from dispersed endocrine system. Their incidence is estimated to be five cases per 100 000 population, although the true incidence may be higher as the consequence of often oligosymptomatic course of disease and indolent behaviour of NETs. The most typical localization of NETs is gastrointestinal tract and bronchi. However they may develop in every organ of the body containing neuroendocrine cells. The diagnosis of NET is...

Primary pigmented nodular adrenocortical disease (PPNAD) is a rare cause of ACTH independent adrenal Cushing’s syndrome. A 32-year-old female with atrial myxomas was found to have Carney’s complex (PRKAR1A mutation negative). Screening showed biochemical Cushing’s syndrome (24 h urine free cortisol 918 nmol – nr 100–400) and the characteristic paradoxical increase in UFC during the 48 h dexamethasone suppression test was confirmed: 24 h UFC pre-dex 340...

Hungry bone syndrome is common in tertiary hyperparathyroidism after parathyroidectomy. Less frequently, it has been described after thyroidectomy in patients with hyperthyroidism. We hereby report a case of hungry bone syndrome in a patient who suffers with Graves’ disease.A 44-year-old woman with a history of refractory Graves’ disease presented with 4 weeks history of shortness of breath, palpitations and peri-oral paraesthesia following tot...

We present the case of a 72-year-old gentleman was admitted to our hospital with atrial fibrillation secondary to severe hypokalemia of 1.8 mmol/l, but normal serum sodium and creatinine. He had prostate cancer with extensive liver and bone metastases. After potassium supplementation 180–200 mmol/day for 10 days serum levels persisted between 2.3 and 2.9 mmol/l. During this short period he developed early Cushingoid features, jaundice and diabetes. After overnignt dexamet...

Herein, we present a case of a 68-year-old woman who had hyperthyroidism and a large mass lesion in the upper portion of her right lung. The patient had a history of previous subtotal thyroidectomy 40 years before. A few years after the operation she noticed some enlargement on her neck. Two years before the admission she was evaluated for some unrelated complaint and a large mass was discovered on her right lung on X-ray examination and she was considered to have a lung cance...

Background: Swyer syndrome is a type of pure gonadal dysgenesis 46 XY caryotype in phenotypically female patients. A rare case of Swyer syndrome complicated by dysgerminoma and Retiform Sertoli-Leydig cell’s tumor is reported.Case presentation: A 20-year-old phenotypically female patient presented to our department with primary amenorrhea. She was 1.68 m and weighed 82 kg (BMI 28). She presented with minimal breast development, sparse axillary and p...

Patients with inappropriate TSH syndrome have elevated serum free thyroxine (FT4) and free triiodothyronine (FT3) concentrations and normal or slightly elevated serum thyroid stimulating hormone (TSH) level. Inappropriate TSH syndrome include generalized resistance to thyroid hormone (GRTH), pituitary resistance of thyroid hormone (PRTH) and TSHoma.We report here three cases that the first patient has GRTH, the second has TSHoma and third patient has PRT...

Introduction: The stromal luteoma of the ovary is a rare tumour occurring mostly in post menopausal women. Endocrine symptoms and sometimes virilizing signs may be observed, although abnormal vaginal bleeding is the most frequent manifestation. This tumour is surrounded by ovarian stroma being entirely composed of luteinized cells devoid of crystals of Reinke. Hyperthecosis of ovarian stroma is often observed. Its evolution is always benign.Case report: ...

Thyrotoxicosis and primary hyperaldosteronism both cause hypokalemic periodic paralysis. A 51-year-old woman, with a history of 3 episodes of transient muscle weakness, was admitted to the emergency unit with complaint of the weakness of legs. Her medical history included hypertension for 10 years. A nodule approximately 3 cm in diameter was palpated in the left anterior neck. Decreased strength (2/5) and deep tendon reflexes in lower extremities symmetrically with normal sens...

Introduction: Anorchia or vanishing testis syndrome is defined as the absence of testicular tissue in genetic and phenotypic males. To establish this diagnosis certain criteria must be present, namely non palpable testis during examination under anaesthesia and blind ending spermatic vessels visualized within the retroperitoneu, or the spermatic vessels and vas deferens exiting a closed internal inguinal ring. Bilateral congenital anorchia affects one in 20 000 males.<p cl...

Patient DE, a 49-year-old woman, was operated in 2005 for two giant-cell tumours of the mandible, and in 2008 for another tumour with the same localisation and histology. Inferior cervical ultrasound after the second surgery revealed a parathyroid adenoma of 20×27×15 mm behind the lower pole of the right thyroid lobe, confirmed by Tc tetrofosmin scintigraphy. The patient had metabolic features suggestive for primary hyperparathyroidism: calcium – 10.9 mg/dl (nor...

Pheocromocytoma is a catecholamine-secreting tumor that arises from chromaffin cells of the adrenal medulla. In general, they are unilateral and the treatment of choise is complete surgical resection. Surgery and other medical procedures such as chemotherapy or radiotherapy may result in massive catecholamine release that can be fatal. Some form of preoperative pharmacologic preparation is indicated for all patients to control blood pressure, arrhytmia and promote intravascula...

Graves’ disease is characterized by the occurrence of antibodies against thyroid-stimulating hormone (TSH) receptor that stimulate the gland to produce T4 and T3. It can be accompanied by an infiltrative orbitopathy and oftalmopathy. Another seldom- regognized feature of this disease is thymic hyperplasia.The authors report the case of a 22-year-old woman with Graves’ disease (TSH receptor antibodies 178 U/l) with exuberant oftalmopathy and an ...

Objective: Pendred syndrome is an autosomal recessive disorder characterized by sensorineural hearing loss, goiter, and a partial defect in iodide organification. Pendred syndrome is caused by mutations in the SLC26A4 gene. Here, we report a patient with pendred syndrome and papillary thyroid carcinoma.Case report: A 19-year-old man admitted to our clinic with swelling in his neck. Congenital hypothyroidism was diagnosed at the age of one. His twin broth...

Introduction: The mammary cancer is the most frequent malign tumor encountered in females, characterized by a high distant metastasis tendency. Among the potential prognosis factors, we mention the biomarkers that measure or are associated with biologic processes involved in the tumorous progression. The study analyzes the p53 protein’s positivity in correlation with the mammary cancer’s classical prognosis factors: the hystologic type, the histopathologic degree, th...

Thyroid pathology, as a part of Schmidt’s syndrome, could be presented as a chronic autoimmune thyroiditis (95–97%) or as a Grave’s disease (3–5%). Usually refractory hypothyroidism develops after a chronic autoimmune thyroiditis occurs, so the permanent thyroid hormone replacement is necessary during all life. But we are investigating a different course of that disease.A 31-year-old woman had been sick from 2003, when Schmidt’s ...

Introduction: Case reports of individuals with non-insulinoma hyperinsulinic hypoglcaemia of organic origin has been more frequently described in literature. This syndrome has been described as a rare complication of bariatric surgeries and the term of NIPHS (non-insulinoma pancreatogenic hypoglycemia syndrome) has been proposed.Aim: The aim of our study is to present patients case who had previously undergone the gastric surgery. Bilroth II and finally ...

Introduction: Pheochromocytoma is usually benign neuroendocrine tumor arising from chromaffin cells. Malignant tumors which account for 5–26% mainly metastize to bones, lungs, liver, but very rarely to brain. The coexistence of pheochromocytoma with brain meningioma may hinder the diagnosis.Aim: The aim of this study is to present the case of a malignant pheochromocytoma female with brain metastases and coexisting meningioma.C...

In postmenopausal women with clinical hyperandrogenism Cushing’s syndrome and adrenal/ovarian neoplasms must be excluded, but radiological and biochemical studies are not always useful for localizing the source of androgens.Case 1: A 75-year-old woman developed alopecia and progressive hair growth on the chest and abdomen over 4 months. Five years before a successful parathyroidectomy had been carried out. Hormonal evaluation: Testosterone (T): 5.84...

Angelman syndrome (AS) and Prader-Willi syndrome (PWS) are distinct neurogenetic disorders involving the imprinting mechanism at 15q11–13 region. We report on 4 years and 9 months old boy who was referred to our laboratory in order to investigate a clinical bilateral cryptorquidy. The patient was born to non-consanguineous and healthy biological parents. Informed consent for publication was obtained from the parents. After normal pregnancy, the patient was delivered by ca...

Seckel syndrome (SS) is a rare disorder of severe growth retardation and craniofacial-skeletal abnormalities. In scant number of reports, neonates had intact hypothalamic–pituitary–adrenal axis before they die because of cardiopulmonary abnormalities. We present an unique case of SS at the age of 18 years and discuss the possible explanations of his growth retardation and sex reversal.Case: A 18-year-old female presented with short stature and ...

Adrenoleukodystrophy has a prevalence rate of 1:20 000 and is a cause of adrenal insufficiency in association with demyelination within the nervous system due to a failure of β-oxidation of fatty acids within peroxisomes due to reduced activity of very long chain acyl-CoA synthetase. Several forms are recognized; a childhood cerebral form (30 to 40% cases), adult adrenomyeloneuropathy (40% cases), and Addison’s disease only (7% cases). Adrenomyeloneuropathy, by contr...

Thyroglossal ductal cyst is the most common congenital cervical pathology. Abnormalities in the embryologic development and migration of the thyroid gland can result in this ectopic thyroid tissue, which may occur in the midline in any position from the base of the tongue to the mediastinum. They are rarely seen in adults. Malignant transformation of the cyst is quite rare and is encountered mostly in adults.We retrospectively reviewed two cases of thyro...

Background: Triple-X (Trisomy X) is found in approximately 1 per 1000 females. Mental retardation is the most common feature in triple-X females. Women with Triple X usually are fertile, but they sometimes get the menopause earlier than other women. They are not generally phenotypically abnormal. Although reproductive organs, pubertal development, and fertility are normal in most cases. Some are first identified in infertility clinics, others in institutions for the mentally r...

Although the prognosis of thyroid cancer is in general quite favorable when standard management paradigms are applied, some patients do much less well. Radioactive iodine refractory, recurrent or metastatic disease is prognostically more worrisome. Sorafenib, a multitargeted small molecule kinase inhibitor, including the VEGF receptor and BRAF kinase, has been evaluated in patients with thyroid cancer. The aim of the study was to present a case of metastatic thyroid cancer and...

Introduction: Insulin autoimmune syndrome (IAS) is a clinical condition characterized by the presence of autoantibodies to insulin or insulin receptors in patients not previously treated with insulin. This syndrome has been reported mainly in Asia, and it is a rare cause of hypoglycemia in Caucasians. So far there are no reports of IAS in patients with type 2 diabetes mellitus never treated with insulin.Case report: The authors describe a 59-year-old Cau...

Background: Struma ovarii is a rare form of the ovarian germ cell tumors composed predominantly of mature thyroid tissue. It occurs mostly in the fifth decade. About 5–10% of these tumors are malignant. We present the case of a 20-year-old-woman with papillary thyroid carcinoma arising in struma ovarii.Case report: A 20-year-old woman presented to her gynecologist with pelvic pain. A right ovarian tumor was discovered at ultrasound examination. The ...

Introduction: Incidentaloma is a randomly discovered tumor with no apparent secretor activity. The term is mainly used for hypophysis and adrenals. There are relatively few situations where a patient has more than one such mass.Aim: To present the case of a patient with three tumors: a pituitary mass and bilateral adrenal masses, with clinical manifestations of Cushing’s syndrome.Case report: A 37-year-old female patient who h...

Introduction: Dopamine agonists have been routinely used in the treatment of prolactinomas since 1971. Increasingly, cabergoline is used as first-line treatment because of its tolerability and improved patient compliance. CSF rhinorrhoea is a rare but recognised adverse effect of rapid tumour shrinkage following dopamine agonist therapy. We report a case of cabergoline induced CSF rhinorrhoea in a young man with macroprolactinoma.Case: A 26-year-old stud...