Brain abscess as the initial presentation of a macroprolactinoma: Case report

Area of Science:

• Neuroendocrinology
• Neurosurgery
• Infectious Diseases

Background:

• Macroprolactinomas can invade the skull base, potentially causing bone defects and pathogen entry.
• Pituitary adenomas, particularly macroprolactinomas, can present with invasive behavior.
• Invasive pituitary adenomas pose risks for complications like infections and vascular events.

Observation:

• A 34-year-old male presented with meningitis symptoms, including fever, headache, neck stiffness, and diplopia.
• Brain MRI revealed bilateral fronto-parietal abscesses, intracranial venous sinus thrombosis, and a pituitary adenoma eroding into the sphenoid sinus.
• Hormonal analysis indicated hyperprolactinemia with suppressed FSH, LH, and testosterone levels.

Findings:

• The patient underwent antibiotic treatment and surgical intervention.
• Despite treatment, the patient developed central deafness as a neurological deficit.
• The pituitary adenoma's invasive nature was linked to the intracranial complications.

Implications:

• This case highlights the importance of considering pituitary adenomas in the differential diagnosis of meningitis.
• The rare presentation of intracranial abscess and sinus thrombosis secondary to a pituitary adenoma underscores the need for comprehensive diagnostic workups.
• Clinicians should be aware of the potential for severe neurological complications arising from invasive pituitary adenomas.