{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:40:07Z","timestamp":1756309207936,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,8,2]]},"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>Intracranial hypotension may result in pituitary gland enlargement due to compensatory hyperaemia and venous engorgement. Spontaneous intracranial hypotension (SIH) is frequently associated with connective tissue disorders predisposing patients to dural weakening including dural ectasia and meningeal diverticula. Symptoms of SIH typically include postural headache, dizziness and tinnitus. We present a case of a female in her 20s with Marfan syndrome and a history of pituitary adenoma, who reported intractable postural headaches. Hormonal workup revealed no abnormalities, whereas brain MRI showed sequelae of intracranial hypotension. Further MRI studies revealed thoracic and lumbar meningeal diverticula with significant dural sac ectasia at the L4\u2013S2 level. Myelogram confirmed numerous lumbar spine diverticula with cerebrospinal fluid leak at the L5 and S1 right nerve roots. The patient underwent blood patch administrations at the level of the leak with improvement of symptoms.<\/jats:p>","DOI":"10.1136\/bcr-2024-260189","type":"journal-article","created":{"date-parts":[[2024,8,25]],"date-time":"2024-08-25T10:40:20Z","timestamp":1724582420000},"page":"e260189","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pituitary pseudo-adenoma from cerebrospinal fluid leak in patient with Marfan syndrome"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7811-9607","authenticated-orcid":false,"given":"Ewelina","family":"Niedzialkowska","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arati","family":"Kelekar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,8,25]]},"reference":[{"key":"2025082708271353000_17.8.e260189.1","first-page":"236","article-title":"Diagnosis, Treatment, and Outcome of Pituitary Tumors and Other Abnormal Intrasellar Masses: Retrospective Analysis of 353 Patients","volume":"78","author":"Gsponer","year":"1999","journal-title":"Medicine (Abingdon)"},{"key":"2025082708271353000_17.8.e260189.2","doi-asserted-by":"publisher","DOI":"10.1385\/EP:16:2:133"},{"key":"2025082708271353000_17.8.e260189.3","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.213.2.r99nv02383"},{"key":"2025082708271353000_17.8.e260189.4","doi-asserted-by":"publisher","DOI":"10.1210\/jc.78.3.555"},{"key":"2025082708271353000_17.8.e260189.5","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1007\/s11102-022-01296-y","article-title":"Pituitary enlargement in patients with cerebrospinal fluid drainage due to ventricular shunt insertion: know the condition and do not mistake for adenoma","volume":"26","author":"Grzywotz","year":"2023","journal-title":"Pituitary"},{"key":"2025082708271353000_17.8.e260189.6","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1212\/WNL.0000000000002986","article-title":"A classification system of spontaneous spinal CSF leaks","volume":"87","author":"Schievink","year":"2016","journal-title":"Neurology (ECronicon)"},{"key":"2025082708271353000_17.8.e260189.7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.19.2286"},{"key":"2025082708271353000_17.8.e260189.8","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000097200.18478.7B"},{"key":"2025082708271353000_17.8.e260189.9","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1001\/jamaneurol.2020.4799","article-title":"Clinical Presentation, Investigation Findings, and Treatment Outcomes of Spontaneous Intracranial Hypotension Syndrome: A Systematic Review and Meta-analysis","volume":"78","author":"D\u2019Antona","year":"2021","journal-title":"JAMA Neurol"},{"key":"2025082708271353000_17.8.e260189.10","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-008-0445-z"},{"key":"2025082708271353000_17.8.e260189.11","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1212\/WNL.55.12.1895","article-title":"Pituitary enlargement in patients with intracranial hypotension syndrome","volume":"55","author":"Alvarez-Linera","year":"2000","journal-title":"Neurology (ECronicon)"},{"key":"2025082708271353000_17.8.e260189.12","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.3171\/2014.9.JNS132687","article-title":"Hyperprolactinemia due to spontaneous intracranial hypotension","volume":"122","author":"Schievink","year":"2015","journal-title":"J Neurosurg"},{"key":"2025082708271353000_17.8.e260189.13","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-011-1099-x"},{"key":"2025082708271353000_17.8.e260189.14","doi-asserted-by":"crossref","unstructured":"Yeh Y-C , Lin Y-J , Yeh C-H , et al . Anterior sacral meningocele repair assisted by intraoperative intrathecal fluorescence and 3D printing model: illustrative case. J Neurosurg Case Lessons 2021;1. doi:10.3171\/CASE20159","DOI":"10.3171\/CASE20159"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-260189","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:27:21Z","timestamp":1756308441000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-260189"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8]]},"references-count":14,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8,25]]},"published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1136\/bcr-2024-260189"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-260189","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2024,8]]}}}