Cerebrospinal fluid rhinorrhea: a complication of therapy for invasive prolactinomas

The majority of invasive prolactinomas can be predicted with a high probability if the preoperative prolactin level is above 2000 ng/ml. As these tumors cannot be extirpated radically, adjunctive radiation therapy is used to improve the results of treatment. On the basis of reports that bromocriptine induces tumor shrinkage and has an antimitotic effect, we combined adjunctive irradiation with bromocriptine therapy in 14 patients who had particularly extensive invasion. Two of these patients developed cerebrospinal fluid rhinorrhea 3 and 5 months, respectively, after the completion of radiation therapy. In both patients, the fistula was localized in the sellar region and was closed successfully. Rapid tumor shrinkage caused by irradiation combined with bromocriptine therapy may be a factor causing this complication; postoperative rhinorrhea is otherwise extremely rare in our surgical series. We also observed a third patient who did not have an operation, but who developed rhinorrhea after a course of irradiation and bromocriptine treatment. The periods of rhinorrhea coincided with periods of bromocriptine treatment.