Endocrine Abstracts

A 48-year-old gentleman was admitted to AMU overnight in January’12 from eye casualty with weeks of worsening visual disturbances followed by rapid deterioration – complete loss of vision in the right eye and a temporal hemianopia on the left side but no headache.

Urgent hormone profile revealed elevated prolactin 53 988 mU/l, low testosterone of 3.3, SHBG 22, LH 2, FSH 3.1, IGF1 292, satisfactory SST (0 min cortisol 213 with ACTH 10 and 30 min cortisol 630), FT₄ 11, TSH 1.2. MRI pituitary showed ‘A macroadenoma (40×31×26 mm) compressing the optic chiasm. No evidence of apoplexy.’ He was started on Cabergoline 500 μg once a week and discharged.

He came back to endocrine clinic 3 days later with improved vision and doubled Cabergoline dose. Seen in Pituitary MDT in 2 weeks as he had developed quite significant CSF leak from the left nostril a week ago. He underwent joint Neurosurgical and ENT procedure to repair the leak.

Reviewed in April’12 – feels tired and lack of libido (prolactin 1500, testosterone 4.4). Started on testosterone gel. MRI pituitary showed reduction in macroadenoma (28×28×28 mm) with no significant optic chiasm compression. Last seen in pituitary MDT in February’16. His prolactin is 810 and normal vision. The MRI shows mainly post-surgical packing of the sphenoid fossa with no suggestion of a problematic tumour mass with a prolactinoma.

This case highlight that sudden shrinkage of the macroprolactinoma with dopamine agonist can leave a hole in the dura leading to CSF leak. The patient needs to be warned about this and manage accordingly.