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Updated: Jun 21, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Is surgical intervention frequently required for medically managed macroprolactinomas? A study of spontaneous
Patricia de Lacy1, Silas Benjamin, Rebecca Dixon
1Department of Neurosurgery, Morriston Hospital, Swansea, UK. pdelacy44@hotmail.com
Background:
The frequency of spontaneous CSF rhinorrhea in macroprolactinoma patients is poorly documented and was previously thought to be a very rare occurrence.
Methods:
Thirty patients with macroprolactinomas (>1.0 cm diameter) identified from the Swansea neuroendocrine database were studied retrospectively.
Results:
At presentation, the median serum prolactin was 28,354 (range, 1844 to >6,000,000) mU/L; radiologically, 4 adenomas were invading the cavernous sinus, one the sphenoid sinus and 5 both the cavernous and sphenoid sinus. After commencement of medical therapy, 4 subjects developed CSF rhinorrhea requiring surgical correction; all 4 had tumors invading both the cavernous and sphenoid sinus and an initial serum prolactin more than 75,000 mU/L. One subject developed an acute psychosis, and a man who presented with delayed puberty committed a serious sexual offense.
Conclusions:
Serious adverse effects are not uncommon in medically treated macroprolactinoma patients. Subjects with adenomas invading the sphenoid sinus have a high risk of developing CSF rhinorrhea that requires neurosurgical intervention.
Insights
Spontaneous CSF rhinorrhea is a significant risk in macroprolactinoma patients, especially with sphenoid sinus invasion. Medical therapy can precipitate this complication, necessitating neurosurgical intervention.
Area of Science:
- Neuroendocrinology
- Neurosurgery
- Oncology
Background:
- Spontaneous cerebrospinal fluid (CSF) rhinorrhea is infrequently documented in macroprolactinoma patients.
- Previous understanding suggested this complication was exceedingly rare.
Purpose of the Study:
- To investigate the incidence and risk factors of spontaneous CSF rhinorrhea in macroprolactinoma patients.
- To evaluate adverse effects associated with medical therapy for macroprolactinomas.
Main Methods:
- Retrospective analysis of 30 patients with macroprolactinomas (>1.0 cm) from the Swansea neuroendocrine database.
- Review of patient data including serum prolactin levels, tumor invasion extent, and treatment outcomes.
Main Results:
- Four patients developed CSF rhinorrhea requiring surgery after initiating medical therapy.
- All four patients with CSF rhinorrhea had tumors invading both the cavernous and sphenoid sinuses and high initial prolactin levels (>75,000 mU/L).
- Other serious adverse events included acute psychosis and a sexual offense in one patient each.
Conclusions:
- Serious adverse effects are not rare in medically treated macroprolactinoma patients.
- Macroprolactinomas invading the sphenoid sinus pose a high risk for developing CSF rhinorrhea.
- CSF rhinorrhea in these patients often necessitates neurosurgical intervention.
