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Acute aseptic meningitis as the initial presentation of a macroprolactinoma

Marina Boscolo1, Danielle Baleriaux, Nathalie Bakoto

  • 1Department of Endocrinology, Erasme Hospital, Route de Lennik 808, 1070 Brussels, Belgium. marina.boscolo@erasme.ulb.ac.be.

BMC Research Notes
|January 9, 2014
PubMed
Abstract

Insights

Meningitis can occur with untreated pituitary macroadenomas, even without cerebrospinal fluid (CSF) leakage. Prompt diagnosis and treatment are crucial for patients with pituitary masses presenting with headache and inflammation.

Area of Science:

  • Endocrinology
  • Neurology
  • Infectious Diseases

Background:

  • Meningitis is a rare complication of untreated pituitary macroadenomas.
  • Cerebrospinal fluid (CSF) rhinorrhea is more commonly associated with treated macroadenomas or post-surgical complications.

Observation:

  • A 31-year-old male presented with headache, fever, and visual loss due to an invasive pituitary macroadenoma.
  • Initial presentation did not involve clinically detected CSF leakage, but lumbar puncture revealed acute bacterial meningitis.

Findings:

  • The patient had elevated inflammatory markers, hyperprolactinemia (9000 ng/ml), and panhypopituitarism.
  • Endoscopic surgery revealed a large tumor destroying the sphenoid floor.

Implications:

  • Meningitis must be considered in pituitary mass patients with headache and elevated inflammatory markers, even without CSF rhinorrhea.
  • Early diagnosis and management of meningitis in pituitary macroadenoma patients are vital for favorable outcomes.

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