Leong K S, Foy P M, Swift A C, Atkin S L, Hadden D R, MacFarlane I A
University Clinical Department of Diabetes and Endocrinology, University Hospital Aintree, Liverpool, UK.
Clin Endocrinol (Oxf). 2000 Jan;52(1):43-9. doi: 10.1046/j.1365-2265.2000.00901.x.
The management of CSF rhinorrhoea following dopamine agonist (DA) treatment for invasive prolactinomas is difficult and there is no clear consensus for its treatment. Our objective was therefore to investigate the different treatments for this condition.
We examined the case notes of five patients with invasive prolactinomas and CSF rhinorrhoea following DA treatment. The different ways in which this complication had been managed is detailed along with a review of the literature.
Five patients aged 24-67 years (3 male) with massive invasive prolactinomas (serum prolactin 95000-500000 mU/l) eroding the skull base were treated with dopamine agonists (3 bromocriptine, 1 cabergoline and 1 both). CSF rhinorrhoea developed in all patients between 1 week and 4 months after commencing dopamine agonist treatment. In two patients (cases 1 and 4), CSF rhinorrhoea ceased within a few days of stopping bromocriptine but restarted when treatment was resumed. One of these (case 4), a 67-year-old woman had no further treatment and CSF leakage stopped completely. She died of unrelated medical problems 3 years later. In one patient staphylococcus aureus meningitis and pneumocephalus developed as a complication of CSF rhinorrhoea. Three patients had endoscopic nasal surgery to repair the fistula using muscle grafts, and to decompress the pituitary tumour, with success in two. One patient had intracranial surgery and dural repair, which was successful in sealing the leak.
We suggest that surgery as soon as is feasible is the treatment of choice for the repair of a CSF leak following dopamine agonist treatment. An additional strategy is the withdrawal of dopamine agonist to allow tumour re-growth to stop the leak.
多巴胺激动剂（DA）治疗侵袭性泌乳素瘤后脑脊液鼻漏的处理较为困难，且其治疗尚无明确共识。因此，我们的目的是研究针对这种情况的不同治疗方法。
我们检查了5例接受DA治疗后发生侵袭性泌乳素瘤和脑脊液鼻漏患者的病历。详细介绍了处理该并发症的不同方法，并对文献进行了综述。
5例年龄在24 - 67岁（3例男性）的患者，患有侵袭性巨大泌乳素瘤（血清泌乳素95000 - 500000 mU/l）并侵蚀颅底，接受了多巴胺激动剂治疗（3例使用溴隐亭，1例使用卡麦角林，1例两者都用）。所有患者在开始多巴胺激动剂治疗后1周内至4个月之间出现脑脊液鼻漏。在2例患者（病例1和4）中，停用溴隐亭后几天内脑脊液鼻漏停止，但恢复治疗时又重新出现。其中1例（病例4），一名67岁女性未再接受治疗，脑脊液漏完全停止。3年后她死于其他无关的医疗问题。1例患者发生金黄色葡萄球菌脑膜炎和气颅，作为脑脊液鼻漏的并发症。3例患者接受了内镜下鼻腔手术，使用肌肉移植修复瘘管，并对垂体肿瘤进行减压，2例成功。1例患者接受了开颅手术和硬脑膜修复，成功封闭了漏口。
我们建议，一旦可行，手术是修复多巴胺激动剂治疗后脑脊液漏的首选治疗方法。另一种策略是停用多巴胺激动剂，使肿瘤停止生长以止住漏液。
