Endocrine Abstracts

Prolactinomas are the most common hormonally active tumours of the pituitary. The treatment of choice is pharmacological. They are treated with cabergolin, which decreases the level of prolactin as well as the size of the tumour. Rarely, dangerous complications can arise after a quick reduction of the tumour’s size.

Case presentation: Two men with macroprolactinomas were initially treated with cabergoline (Dostinex®) in a dose of 1 mg per week with increase to 2 mg per week after 7 days of treatment. Six to seven weeks after the initiation of treatment, rhinorrhea appeared in both patients. The first patient experienced headaches and a worsening of ocular perimeter on the right side. Cranial computed tomography scans showed pneumocephalus in both patients. In the first patient, there were no findings of cranionasal communication on cisternography. After withdrawal of cabergoline, the pneumocephalus had gradually reduced in size. In the second patient, two endoscopic transsphenoidal repairs of the defect were performed as well as tumour debulking. After the surgery cabergoline was once again started in lower doses for visual field defects.

Conclusion: Pneumocephalus is a rare complication in pharmacologically treated macroprolactinomas. Quick diagnosis and urgent surgical treatment are of utmost importance.