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Brain & Chiasmal Herniations into Sella after Medical Treatment of Prolactinoma

Published online by Cambridge University Press:  02 December 2014

M.H. Bangash ,
D.B. Clarke  and
R.O. Holness
M.H. Bangash
Affiliation:
Department of Surgery (Neurosurgery), Dalhousie University, Halifax, Nova Scotia, Canada
D.B. Clarke*
Affiliation:
Department of Surgery (Neurosurgery), Dalhousie University, Halifax, Nova Scotia, Canada
R.O. Holness
Affiliation:
Department of Surgery (Neurosurgery), Dalhousie University, Halifax, Nova Scotia, Canada
*
QEII Health Sciences Centre - Halifax Infirmary, Room 3807, 1796 Summer Street, Halifax, Nova Scotia, B3H 3A7, Canada
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Abstract:

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Background:

Dopamine agonists are widely used in the treatment of pituitary prolactinomas. We report a case of inferior mesial frontal lobe (gyrus rectus) and chiasmal herniations into an enlarged sella following successful medical treatment of a pituitary macroadenoma.

Method:

A 71-year-old healthy man presented to medical attention with visual complaints. On examination, he was found to have bitemporal hemianopsia. Endocrine evaluation revealed an elevated prolactin level. He was treated medically with a dopamine agonist (bromocriptine).

Results:

Evaluation after one year of medical treatment revealed stabilization of the patient's vision, with a significant bitemporal field loss. Serum prolactin levels normalized (5.16 ng/ml). The MRI of the sella showed almost complete disappearance of the tumor, resulting in right mesial frontal lobe herniation inferiorly into an enlarged sella with associated chiasmal deformation.

Conclusions:

We report a case where successful medical treatment of a large pituitary prolactinoma has resulted in inferior frontal lobe and chiasmal herniatons into an enlarged sella.

Résumé:

RÉSUMÉ:Contexte:

Les agonistes de la dopamine sontlargementutilisésdans le traitement des prolactinomespituitaires. Nous rapportons un cas d’hernie du lobe frontal mésial inférieur (gyrus rectus) et du chiasmadansuneselleturciqueagrandie suite à la régression d’un macroadénome pituitaire traité médicalement avec succès.

Méthode:

Un hommeâgé de 71 ans, en bonne santé, a consulté pour des troubles visuels. À l’examen on a noté une hémianopsie bitemporale. L’évaluation endocrinienne a montré un niveauélevé de prolactine. Il a été traité médicalement par un agoniste de la dopamine, la bromocriptine.

Résultats:

Après un an de traitement, la vision du patient était stable, mais il accusaituneperteimportante au niveau des champs visuelstemporaux. Le niveau sérique de prolactineétait normal, soit de 5,16 ng/mL.À l’IRM de la selleturcique, la tumeuravaitpresquecomplètement disparuentraînant unehernie de la partie mésiale droite du lobe frontal vers le bas associée à une déformation du chiasma dans une selle turciquea grandie.

Conclusions:

Nous rapportons l’observation d’un patient porteur d’un grosprolactinomepituitaire traité médicalement avec succès entraînant unehernie du lobe frontal inférieur et du chiasma dans une selle turciquea grandie.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 33 , Issue 2 , May 2006 , pp. 240 - 242
Copyright
Copyright © The Canadian Journal of Neurological 2006

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