Abstract
Optic chiasmal herniation following dopamine agonist therapy is a rare complication in patients with giant prolactinomas. But there are a few case reports of brain and chiasmal herniation following medical therapy in such cases. We report a young man who developed secondary visual loss and seizures after 6 months of medical treatment with cabergoline for giant prolactinoma. Magnetic resonance imaging of hypothalamic pituitary region revealed optic chiasmal and frontal lobe herniation into sella. There was marginal improvement in his vision after cabergoline dose reduction. The present case report highlights frontal lobe herniation in conjunction with optic chiasmal herniation as a very rare complication of medical therapy of giant prolactinoma. Different treatment options of this condition are being discussed.
References
Ivan G, Szigeti-Csucs N, Olah M, Nagy GM, Goth MI (2005) Treatment of pituitary tumors: dopamine agonists. Endocr 28(1):101–110. doi:10.1385/ENDO:28:1:101
Jones SE, James RA, Hall K, Kendall-Taylor P (2000) Optic chiasmal herniation—an under recognized complication of dopamine agonist therapy for macroprolactinoma. Clin Endocrinol (Oxf) 53(4):529–534. doi:10.1046/j.1365-2265.2000.01039.x
Taxel P, Waitzman DM, Harrington JF Jr, Fagan RH, Rothfield NF, Chen HH, Malchoff CD (1996) Chiasmal herniation as a complication of bromocriptine therapy. J Neuroophthalmol 16(4):252–257. doi:10.1097/00041327-199612000-00005
Chuman H, Cornblath WT, Trobe JD, Gebarski SS (2002) Delayed visual loss following pergolide treatment of a prolactinoma. J Neuroophthalmol 22(2):102–106. doi:10.1097/00041327-200206000-00008
Raverot G, Jacob M, Jouanneau E, Delemer B, Vighetto A, Pugeat M, Borson-Chazot F (2009) Secondary deterioration of visual field during cabergoline treatment for macroprolactinoma. Clin Endocrinol 70(4):588–592
Bangash MH, Clarke DB, Holness RO (2006) Brain and chiasmal herniations into sella after medical treatment of prolactinoma. Can J Neurol Sci 33(2):240–242
Kaufman B, Tomsak RL, Kaufman BA, Arafah BU, Bellon EM, Selman WR et al (1989) Herniation of the suprasellar visual system and third ventricle into empty sellae: morphologic and clinical considerations. AJR Am J Roentgenol 152(3):597–608
Keyaki A, Makita Y, Nabeshima S, Motomochi M, Itagaki T, Tei T (1982) Secondary empty sella syndrome: report of three cases and review of the literature. No Shinkei Geka 10(11):1189–1194
Zona G, Testa V, Sbaffi PF, Spaziante R (2002) Transsphenoidal treatment of empty sella by means of a silastic coil; a technical note. Neurosurgery 51(5):1299–1303. doi:10.1097/00006123-200211000-00032
Kubo S, Hasegawa H, Inui T, Tominagas S, Yoshimine T (2005) Endonasal endoscopic transsphenoidal chiasmapexy with silicone plates for empty sella syndrome: technical note. Neurol Med Chir (Tokyo) 45(9):491
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Dhanwal, D.K., Sharma, A.K. Brain and optic chiasmal herniations into sella after cabergoline therapy of giant prolactinoma. Pituitary 14, 384–387 (2011). https://doi.org/10.1007/s11102-009-0179-x
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DOI: https://doi.org/10.1007/s11102-009-0179-x