title: Acute sterile meningitis as a primary manifestation of pituitary apoplexy.
abstract: Pituitary apoplexy is a rare and underdiagnosed clinical syndrome. It results from hemorrhagic infarction of the pituitary gland. In its classical form it is characterized by acute headache, ophthalmoplegia, visual loss and pituitary insufficiency. Meningeal irritation signs, clinically indistinguishable from infectious meningitis, are considered rare and have not been reported as presenting signs. We report a 53-yr-old man who was admitted to hospital following acute headache, fever, neck stiffness and paresis of the left oculomotor and abducent nerves. A lumbar puncture revealed an increased number of polymorphs but with a sterile cerebral spinal fluid. Magnetic resonance imaging (MRI) showed an intrasellar mass with central necrosis in an enlarged sella. Endocrinological evaluation demonstrated insufficient thyroid, adrenocortical, and gonadal function. Necrosis within a chromophobe adenoma was found upon surgical decompression of the sella. After surgery anterior panhypopituitarism did not recover, while ophthalmoplegia subsided. The patient is now in good health under appropriate hormonal replacement therapy.
authors.affiliation: Department of Experimental Medicine and Biochimical Science, Section of Infectious Diseases, Perugia University, Perugia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Valente
authors.forename: M
authors.initials: M
authors.lastname: Marroni
authors.forename: G
authors.initials: G
authors.lastname: Stagni
authors.forename: P
authors.initials: P
authors.lastname: Floridi
authors.forename: G
authors.initials: G
authors.lastname: Perriello
authors.forename: F
authors.initials: F
authors.lastname: Santeusanio
mesh_terms: D000208:Acute Disease; D000236:Adenoma / Q000601:surgery; D003287:Contrast Media; D003937:Diagnosis, Differential; D019786:Gadolinium DTPA; D006728:Hormones / Q000097:blood; D006801:Humans; D008297:Male; D008582:Meningitis, Aseptic / Q000175:diagnosis / Q000209:etiology*; D008875:Middle Aged; D009886:Ophthalmoplegia / Q000209:etiology; D010899:Pituitary Apoplexy / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D010911:Pituitary Neoplasms / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D006728:Hormones; D019786:Gadolinium DTPA