Macroadenoma with CSF leak PI Our case is

Macroadenoma with CSF leak

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 116 ng/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.

Date Prolactin LH FSH TSH Estradiol (ng/ml) (m. Iu/ml) (mic. IU/ml) (pg) 1396/06/09 116 1 2. 5 19. 5 1396/08/13 120 lab 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 LH (m. Iu/ml) (ng/ml) 1397/02/26 391 <0. 1 FSH Estradiol (m. Iu/ml) (pg) 0. 8 45 lab pasteur

Hypophysis MRI (with and without contrast) 1397/03/01 ﻣﺮکﺰ ﺗﺼﻮیﺮ ﺑﺮﺩﺍﺭی پﺰﺷکی آﺴیﺎ 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 T 1 and T 2 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. B 2 - transferrin test was positive, indicating CSF- leakage. She became vaccinated for pneumococ and started co-amoxiclav for meningitis prophylaxy.

Date 1397/04/10 Prolactin TSH ACTH (ng/ml) (mic. IU/ml) (pg/ml) 6. 79 1. 9 13. 6 lab noor

Ph/E On exam she was 163 cm tall and weighted 68 kg, with a BMI of 25. 5 kg/m 2. 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.

Thanks for your attention