Cabergoline-induced CSF rhinorrhea in patients with macroprolactinoma. Report of three cases

Three cases of cerebrospinal fluid (CSF) leak, in subjects with an invasive macroprolactinoma under treatment with cabergoline (CAB), are reported. The patients underwent surgical treatment by means of an endoscopic endonasal transsphenoidal approach, which allowed removal of the lesion and sealing of the fistula. Many cases of CSF rhinorrhea are described in literature after bromocriptine therapy in invasive prolactinomas, but only one report has been recently published of such condition after CAB treatment. The complication is likely due to the brisk cessation of the so-called "stopper effect", i.e. the tumor mechanically blocking the CSF leak in spite of its previous erosion of the skull-base, when CAB induces the macroprolactinoma shrinkage. Endoscopic transsphenoidal surgery offers a safe, minimally invasive and efficient management of this complication, which allows to regularly perform the following steps of the therapeutical strategy against the prolactinoma.