Brain & Chiasmal Herniations into Sella after Medical Treatment of Prolactinoma

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. A 71-year-old healthy man presented to me...

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Bibliographic Details
Published in:Canadian journal of neurological sciences 2006-05, Vol.33 (2), p.240-242
Main Authors: Bangash, M.H., Clarke, D.B., Holness, R.O.
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Bromocriptine - therapeutic use
Case Report
Encephalocele - diagnosis
Encephalocele - etiology
Encephalocele - physiopathology
Forensic medicine
Frontal Lobe - injuries
Frontal Lobe - pathology
Hemianopsia - diagnosis
Hemianopsia - etiology
Hemianopsia - physiopathology
Hormone Antagonists - therapeutic use
Humans
Immunomodulators
Magnetic Resonance Imaging
Male
Medical sciences
Neurology
Neurosurgical Procedures - adverse effects
Optic Chiasm - injuries
Optic Chiasm - pathology
Pharmacology. Drug treatments
Pituitary Neoplasms - surgery
Postoperative Complications - etiology
Postoperative Complications - physiopathology
Prolactin - antagonists & inhibitors
Prolactin - blood
Prolactinoma - surgery
Public health. Hygiene
Public health. Hygiene-occupational medicine
Sella Turcica - pathology
Sella Turcica - surgery
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Summary: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. 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). 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. 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.
ISSN:0317-1671
2057-0155
DOI:10.1017/S0317167100005060