Female with Macroadenoma and CSF Leak: Clinical Presentation and Evaluation
A 23-year-old female presented with secondary amenorrhea and spontaneous galactorrhea. Initial findings of PCOD and elevated prolactin levels led to further evaluation by an endocrinologist. Imaging and lab tests revealed significant hormonal abnormalities. MRI showed a normal pituitary gland. Follow-up and management may be crucial for addressing the underlying condition.
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Presentation Transcript
M Macroadenoma acroadenoma with CSF leak CSF leak with
PI : Our case is a 23 year-old female presented with secondary amenorrhea. Her menarche was at 13 years-old and had a regular menstural cycles. She had undergone normal puberty and thelarce with no significant past medical or surgical history. And her family history was unremarkable. About 3 years ago she had missing menstural periods but she had not been evaluated. Last year, In primary work-up, PCOD in sonography and prolactin level of 116ng/ml in lab tests were reported.
She also had spontaneous and bilateral galactorrhea during last year. She had no weight gain, acnea, hirsutism, headache, visual loss, diplopia, ataxia.
1396/06/11 mm 26 * 71 . . 5 . . PCOD RT ovary 50 mm LT ovary 30 mm . UTI . .
Date Prolactin (ng/ml) 116 120 LH FSH (mIu/ml) 2.5 TSH Estradiol (pg) 19.5 lab (mIu/ml) 1 (micIU/ml) 2.5 1396/06/09 1396/08/13 Dr. hojjat Dr. hojjat
After taking Rokin tablet she had regular mensturation just for 4 cycles. But She did not follow up her evaluations up to 2 months ago. She was referred to a endocrinologist and underwent checking lab tests and imaging
Date Prolactin (ng/ml) 391 LH FSH (mIu/ml) 0.8 Estradiol (pg) 45 lab (mIu/ml) <0.1 1397/02/26 pasteur
Hypophysis MRI (with and without contrast) 1397/03/01 The sella shows normal size, position and configuration. The borders of its floor and walls are smooth and sharply defined. It contains no circumscribed hypodense or hyperdense areas. The infundibulum is centered and of normal size. The optic chiasm and suprasellar CSF spaces appear normal The cavernous sinus and imaged portions of the internal carotid artery and carotid siphon are unremarkable. Evaluable portions of the neurocranium show no abnormalities. The sphenoid sinus is clear and pneumatized. 12*14 mm and T1 and T2 isosignal area with mild delay enhancement at mid and left lateral part of pituitary gland abuts chiasma opticum suggestive for pituitary protruding macroadenoma. Germinoma and infundibular tumors such as lymphoma are in differential.
Cabergoline was started in dose of 0.5 mg twice weekly for her. Galactorrhea had been resolved but she mentioned rhinorrhea. B2- transferrin test was positive, indicating CSF- leakage. She became vaccinated for pneumococ and started co-amoxiclav for meningitis prophylaxy.
Date Prolactin (ng/ml) 6.79 TSH ACTH (pg/ml) 13.6 lab (micIU/ml) 1.9 1397/04/10 noor
MRI 1397/04/12 Base 10 * 18 . . CSF leakage . . intact Stalk . . . .
Ph/E On exam she was 163 cm tall and weighted 68 kg, with a BMI of 25.5 kg/m2 . Cardiac and respiratory exams were normal. she had not hirsutism, acnea, steria or evidence of acromegaly.
We refer her to a neurosurgen for evaluation and surgery of CSF leak.
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