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Acute sterile meningitis as a primary manifestation of pituitary apoplexy

M Valente1, M Marroni, G Stagni

  • 1Department of Experimental Medicine and Biochimical Science, Section of Infectious Diseases, Perugia University, Perugia, Italy.

Journal of Endocrinological Investigation
|December 13, 2003
PubMed

Insights

Pituitary apoplexy, a rare condition involving pituitary gland bleeding and damage, can mimic meningitis. This case highlights its unusual presentation with severe headache and neurological deficits.

Area of Science:

  • Endocrinology
  • Neurology
  • Neurosurgery

Background:

  • Pituitary apoplexy is a rare clinical syndrome caused by hemorrhagic infarction of the pituitary gland.
  • Classical symptoms include headache, visual loss, ophthalmoplegia, and pituitary insufficiency.
  • Meningeal signs are rare presenting symptoms of pituitary apoplexy.

Observation:

  • A 53-year-old male presented with acute headache, fever, neck stiffness, and cranial nerve palsies (oculomotor and abducent).
  • Cerebrospinal fluid analysis showed polymorphonuclear pleocytosis but was sterile, mimicking meningitis.
  • MRI revealed an intrasellar mass with central necrosis, indicative of a pituitary lesion.

Findings:

  • Endocrinological assessment confirmed panhypopituitarism, including deficiencies in thyroid, adrenocortical, and gonadal function.
  • Surgical decompression revealed necrosis within a chromophobe adenoma.
  • Post-operatively, ophthalmoplegia resolved, but anterior hypopituitarism persisted.

Implications:

  • This case underscores the importance of considering pituitary apoplexy in the differential diagnosis of acute meningitis-like presentations.
  • Early recognition and neurosurgical intervention are crucial for managing pituitary apoplexy.
  • Long-term hormonal replacement therapy is essential for patients with persistent panhypopituitarism following pituitary apoplexy.

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