Hyperprolactinemia due to spontaneous intracranial hypotension

Wouter I. Schievink, Miriam A Nuno, Todd D. Rozen, M. Marcel Maya, Adam N. Mamelak, John Carmichael, Vivien S. Bonert

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Object Spontaneous intracranial hypotension is an increasingly recognized cause of headaches. Pituitary enlargement and brain sagging are common findings on MRI in patients with this disorder. The authors therefore investigated pituitary function in patients with spontaneous intracranial hypotension. Methods Pituitary hormones were measured in a group of 42 consecutive patients with spontaneous intracranial hypotension. For patients with hyperprolactinemia, prolactin levels also were measured following treatment. Magnetic resonance imaging was performed prior to and following treatment. Results The study group consisted of 27 women and 15 men with a mean age at onset of symptoms of 52.2 ± 10.7 years (mean ± SD; range 17-72 years). Hyperprolactinemia was detected in 10 patients (24%), ranging from 16 ng/ml to 96.6 ng/ml in men (normal range 3-14.7 ng/ml) and from 31.3 ng/ml to 102.5 ng/ml in women (normal range 3.8-23.2 ng/ml). In a multivariate analysis, only brain sagging on MRI was associated with hyperprolactinemia. Brain sagging was present in 60% of patients with hyperprolactinemia and in 19% of patients with normal prolactin levels (p = 0.02). Following successful treatment of the spontaneous intracranial hypotension, hyperprolactinemia resolved, along with normalization of brain MRI findings in all 10 patients. Conclusions Spontaneous intracranial hypotension is a previously undescribed cause of hyperprolactinemia. Brain sagging causing distortion of the pituitary stalk (stalk effect) may be responsible for the hyperprolactinemia.

Original languageEnglish (US)
Pages (from-to)1020-1025
Number of pages6
JournalJournal of Neurosurgery
Volume122
Issue number5
DOIs
StatePublished - May 1 2015
Externally publishedYes

Fingerprint

Intracranial Hypotension
Hyperprolactinemia
Brain
Prolactin
Reference Values
Pituitary Hormones
Pituitary Gland
Age of Onset
Headache
Therapeutics
Multivariate Analysis
Magnetic Resonance Imaging

Keywords

  • Cerebrospinal fluid
  • Diagnostic and operative techniques
  • Headache
  • Intracranial hypotension
  • Low-pressure syndrome
  • Prolactin

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Schievink, W. I., Nuno, M. A., Rozen, T. D., Maya, M. M., Mamelak, A. N., Carmichael, J., & Bonert, V. S. (2015). Hyperprolactinemia due to spontaneous intracranial hypotension. Journal of Neurosurgery, 122(5), 1020-1025. https://doi.org/10.3171/2014.9.JNS132687

Hyperprolactinemia due to spontaneous intracranial hypotension. / Schievink, Wouter I.; Nuno, Miriam A; Rozen, Todd D.; Maya, M. Marcel; Mamelak, Adam N.; Carmichael, John; Bonert, Vivien S.

In: Journal of Neurosurgery, Vol. 122, No. 5, 01.05.2015, p. 1020-1025.

Research output: Contribution to journalArticle

Schievink, WI, Nuno, MA, Rozen, TD, Maya, MM, Mamelak, AN, Carmichael, J & Bonert, VS 2015, 'Hyperprolactinemia due to spontaneous intracranial hypotension', Journal of Neurosurgery, vol. 122, no. 5, pp. 1020-1025. https://doi.org/10.3171/2014.9.JNS132687
Schievink WI, Nuno MA, Rozen TD, Maya MM, Mamelak AN, Carmichael J et al. Hyperprolactinemia due to spontaneous intracranial hypotension. Journal of Neurosurgery. 2015 May 1;122(5):1020-1025. https://doi.org/10.3171/2014.9.JNS132687
Schievink, Wouter I. ; Nuno, Miriam A ; Rozen, Todd D. ; Maya, M. Marcel ; Mamelak, Adam N. ; Carmichael, John ; Bonert, Vivien S. / Hyperprolactinemia due to spontaneous intracranial hypotension. In: Journal of Neurosurgery. 2015 ; Vol. 122, No. 5. pp. 1020-1025.
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abstract = "Object Spontaneous intracranial hypotension is an increasingly recognized cause of headaches. Pituitary enlargement and brain sagging are common findings on MRI in patients with this disorder. The authors therefore investigated pituitary function in patients with spontaneous intracranial hypotension. Methods Pituitary hormones were measured in a group of 42 consecutive patients with spontaneous intracranial hypotension. For patients with hyperprolactinemia, prolactin levels also were measured following treatment. Magnetic resonance imaging was performed prior to and following treatment. Results The study group consisted of 27 women and 15 men with a mean age at onset of symptoms of 52.2 ± 10.7 years (mean ± SD; range 17-72 years). Hyperprolactinemia was detected in 10 patients (24{\%}), ranging from 16 ng/ml to 96.6 ng/ml in men (normal range 3-14.7 ng/ml) and from 31.3 ng/ml to 102.5 ng/ml in women (normal range 3.8-23.2 ng/ml). In a multivariate analysis, only brain sagging on MRI was associated with hyperprolactinemia. Brain sagging was present in 60{\%} of patients with hyperprolactinemia and in 19{\%} of patients with normal prolactin levels (p = 0.02). Following successful treatment of the spontaneous intracranial hypotension, hyperprolactinemia resolved, along with normalization of brain MRI findings in all 10 patients. Conclusions Spontaneous intracranial hypotension is a previously undescribed cause of hyperprolactinemia. Brain sagging causing distortion of the pituitary stalk (stalk effect) may be responsible for the hyperprolactinemia.",
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AU - Carmichael, John

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N2 - Object Spontaneous intracranial hypotension is an increasingly recognized cause of headaches. Pituitary enlargement and brain sagging are common findings on MRI in patients with this disorder. The authors therefore investigated pituitary function in patients with spontaneous intracranial hypotension. Methods Pituitary hormones were measured in a group of 42 consecutive patients with spontaneous intracranial hypotension. For patients with hyperprolactinemia, prolactin levels also were measured following treatment. Magnetic resonance imaging was performed prior to and following treatment. Results The study group consisted of 27 women and 15 men with a mean age at onset of symptoms of 52.2 ± 10.7 years (mean ± SD; range 17-72 years). Hyperprolactinemia was detected in 10 patients (24%), ranging from 16 ng/ml to 96.6 ng/ml in men (normal range 3-14.7 ng/ml) and from 31.3 ng/ml to 102.5 ng/ml in women (normal range 3.8-23.2 ng/ml). In a multivariate analysis, only brain sagging on MRI was associated with hyperprolactinemia. Brain sagging was present in 60% of patients with hyperprolactinemia and in 19% of patients with normal prolactin levels (p = 0.02). Following successful treatment of the spontaneous intracranial hypotension, hyperprolactinemia resolved, along with normalization of brain MRI findings in all 10 patients. Conclusions Spontaneous intracranial hypotension is a previously undescribed cause of hyperprolactinemia. Brain sagging causing distortion of the pituitary stalk (stalk effect) may be responsible for the hyperprolactinemia.

AB - Object Spontaneous intracranial hypotension is an increasingly recognized cause of headaches. Pituitary enlargement and brain sagging are common findings on MRI in patients with this disorder. The authors therefore investigated pituitary function in patients with spontaneous intracranial hypotension. Methods Pituitary hormones were measured in a group of 42 consecutive patients with spontaneous intracranial hypotension. For patients with hyperprolactinemia, prolactin levels also were measured following treatment. Magnetic resonance imaging was performed prior to and following treatment. Results The study group consisted of 27 women and 15 men with a mean age at onset of symptoms of 52.2 ± 10.7 years (mean ± SD; range 17-72 years). Hyperprolactinemia was detected in 10 patients (24%), ranging from 16 ng/ml to 96.6 ng/ml in men (normal range 3-14.7 ng/ml) and from 31.3 ng/ml to 102.5 ng/ml in women (normal range 3.8-23.2 ng/ml). In a multivariate analysis, only brain sagging on MRI was associated with hyperprolactinemia. Brain sagging was present in 60% of patients with hyperprolactinemia and in 19% of patients with normal prolactin levels (p = 0.02). Following successful treatment of the spontaneous intracranial hypotension, hyperprolactinemia resolved, along with normalization of brain MRI findings in all 10 patients. Conclusions Spontaneous intracranial hypotension is a previously undescribed cause of hyperprolactinemia. Brain sagging causing distortion of the pituitary stalk (stalk effect) may be responsible for the hyperprolactinemia.

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