PNEUMATOCYST COMPLICATING A GIANT NECROTIC MACROPROLACTINOMA: ABOUT A VERY RARE CASE

Treatment of patients with giant and invasive macroprolactinomas consists of dopamine agonists (cabergoline or bromocriptine). When they reduce the size of invasive prolactinomas, the intra and extra cranial spaces may communicate causing cerebrospinal fluid (CSF) leakage and / or pneumocephalus which are very scarce complications after medical treatment. We report the case of an 18-year-old girl who was admitted in our department for hormonal evaluation of a pituitary tumor, she had been treated with cabergoline after a giant invasive prolactinoma was diagnosed. After 4 weeks, she presented with severe headaches and liquid nasal discharge, her brain CT showed a skull base lysis with erosion of the sellar floor creating a communication with the sphenoidal sinus resulting in a pneumatocyst. A depletive lumbar puncture was performed, with diamox and prophylactic antibiotics with a good evolution marked by the drying up of the CSF rhinorrhea. Clinicians should be aware of these complications symptoms to ensure proper diagnosis and treatment.