Conservative medical therapy for a macroprolactinoma presenting with obstructive hydrocephalus

Obstructive hydrocephalus is a rare complication of pituitary prolactinomas, especially in women, where symptoms of amenorrhoea rarely go unnoticed. In this study, a case of a female in her 20s with a 2-month history of frontotemporal headache, acutely worsening over 3 days, is presented. Cranial imaging showed a sellar-suprasellar mass (2.6 × 3.5 × 3.6 cm) with associated obstructive hydrocephalus and tonsillar herniation. Hyperprolactinaemia was confirmed, and cabergoline was initiated. Clinically, the patient's headache resolved within 24 hours of the first dose, and repeat prolactin levels fell by 96% within the first month. Repeat imaging confirmed the resolution of the obstructive hydrocephalus within 4 weeks. The patient was able to return to her work, and her menses resumed more than a year later. This case and the corresponding review of the literature demonstrate the possible utility of medical management in cases of obstructive hydrocephalus secondary to a macroprolactinoma.