Other than haemorrhage (more common with bromocriptine), what are two other possible complications related to 'successful' medical management of a prolactinoma?
If the tumour has eroded the pituitary fossa floor into the sphenoid sinus, rapid shrinkage can result in a CSF leak. The optic chiasm, having been gradually stretched by the mass, can eventually prolapse into the enlarged and now mostly empty fossa, and this can result in visual impairment.
There has been remarkable decrease in the size of the pituitary macroadenoma. There is now only small amount of tissue located in the anterior part of the enlarged pituitary fossa, anterior to the normal pituitary tissue. Some tissue continues to bulge into the sphenoid sinus, but this component also has significantly reduced in size. The optic chiasm which had been elevated and compressed by the aforementioned mass has now returned to near-normal position slightly drooping into the enlarged pituitary fossa.
There is no evidence to suggest a defect in the floor of the pituitary fossa and no fluid within the sphenoid sinus to raise suspicion of a CSF leak. The remainder of the study is unremarkable.