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Cerebrospinril fluid rhinorrhea during treatment with bromocriptine for prolactinoma

Departments of Neurology (Drs. Kok and Schulte), Internal Medicine (Drs. Bartelink, Smals. and Pieters). Neurosurgery (Dr. Meyer). and Radiology (Dr. Merx), Radboud IJniversity Hospital, Nijmegen, Holland.

A 47-year-old man exhibited loss of libido and impotence in association with plasma hyperprolactinemia and a pituitary mass with downward extension of the tumor to the sphenoid sinus and to the suprasellar cisterns. Bromocriptine, 15 mg daily, reduced the hyperprolactinemia as well as tumor size. After 8 months on this therapy, the patient developed overt CSF liquorrhea. Five days after discontinuation of bromocriptine, the CSF rhinorrhea stopped, and when bromocriptine was given again 2 weeks later, CSF rhinorrhea returned within 3 days. We believe this phenomenon to be due to retraction of tumor by bromocriptine exposing a defect in the sella floor. Transient occurrence of CSF rhinorrhea can be considered as a consequence of tumor regression in patients on bromocriptine. The possibility of this complication, especially in patients with downward extension of tumor, should be noted.

Address correspondence and reprint requests to Dr. Kok, Department of Neurology III, Fifth Floor, Radboud University Hospital. PO Box 9109. 6500 HB Nijrnegen, Holland.

Accepted for publication November 30, 1984.

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