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Ectopic Prolactinoma Presenting as Bacterial Meningitis: A Diagnostic Conundrum
Oluwaseun O Akinduro1, Olutomi T Akinduro2, Vivek Gupta3
1Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA.
World Neurosurgery
|January 30, 2018
Summary
Ectopic prolactinomas can cause meningitis by eroding the sphenoid sinus. This rare condition requires prompt infection management and surgical repair of the resulting cerebrospinal fluid leak.
Area of Science:
- Neuroendocrinology
- Neurosurgery
- Infectious Diseases
Background:
- Prolactinomas, pituitary tumors, rarely cause meningitis and cerebrospinal fluid (CSF) rhinorrhea.
- Ectopic prolactinomas within the sphenoid sinus are exceptionally rare causes of this communication.
- Atypical growth without pituitary displacement complicates diagnosis.
Observation:
- A 48-year-old woman presented with meningitis symptoms: confusion, headache, and fever.
- Post-antibiotic treatment, she developed salty postnasal fluid leakage, indicating a CSF leak.
- Imaging revealed a sphenoid sinus mass eroding bone, with no pituitary displacement.
Findings:
- Endoscopic biopsy confirmed an ectopic prolactinoma within the sphenoid sinus.
- The cerebrospinal fluid leak was successfully repaired using a nasoseptal flap.
- The patient was treated with cabergoline for the prolactinoma.
Implications:
- Ectopic prolactinomas should be considered in the differential diagnosis of sphenoid sinus masses presenting with meningitis.
- Management priorities include treating the infection and surgically repairing the bony defect.
- This case highlights a rare but critical pathway for meningitis secondary to ectopic pituitary tumors.
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