Prolactinoma – DA-Induced CSF Rhinorrhoea — SCE Neurology MCQ
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Correct answer: A — The dopamine agonist has caused rapid tumour shrinkage, resulting in an opening in the skull base through which CSF leaks — this is a recognised complication of dopamine agonist treatment for large prolactinomas
CSF rhinorrhoea is a recognised complication of dopamine agonist therapy for large invasive prolactinomas. The mechanism is rapid tumour shrinkage creating a defect in the skull base (sphenoid bone) that was previously sealed by the tumour itself. This allows CSF to leak through the nose. Management includes: dose reduction of the dopamine agonist, lumbar drain, and potentially surgical repair of the skull base defect. It is a neurosurgical emergency due to meningitis risk. A: CSF leak is pathological. C: The tumour has shrunk, causing the defect. D: Not an allergic reaction. E: CSF rhinorrhoea is distinguishable from nasal discharge (positive beta-2 transferrin test).
Reference: NICE NG99; Endocrine Society Prolactinoma Guidelines