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Pituitary apoplexy presenting as aseptic meningitis without visual loss or ophthalmoplegia

D C Reutens1, R H Edis

  • 1Royal Perth Hospital, WA.

Australian and New Zealand Journal of Medicine
|August 1, 1990
PubMed

Insights

Pituitary apoplexy can initially present as aseptic meningitis, a rare neurological condition. Subsequent visual impairment and field defects indicate a potential pituitary tumor complication requiring surgical intervention.

Area of Science:

  • Neuroendocrinology
  • Neurology
  • Ophthalmology

Background:

  • Pituitary apoplexy is a rare clinical syndrome typically characterized by sudden onset of headache, visual impairment, and ophthalmoplegia.
  • Aseptic meningitis is an inflammation of the meninges not caused by bacterial infection, often presenting with similar symptoms to bacterial meningitis.

Observation:

  • A patient presented with clinical and cerebrospinal fluid (CSF) findings solely indicative of aseptic meningitis.
  • Later, the patient developed visual impairment and bitemporal hemianopsia, suggesting optic pathway compression.

Findings:

  • Surgical decompression of the sella turcica revealed necrosis within a chromophobe adenoma.
  • The findings confirm that aseptic meningitis can be the initial presentation of pituitary apoplexy.

Implications:

  • This case highlights the importance of considering pituitary apoplexy in the differential diagnosis of aseptic meningitis, especially when accompanied by visual disturbances.
  • Early recognition and surgical intervention are crucial for managing pituitary apoplexy and preventing irreversible vision loss.
  • Pituitary adenomas, particularly chromophobe adenomas, can undergo apoplexy, leading to diverse clinical presentations beyond typical endocrine dysfunction.

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