Pituitary apoplexy masquerading as meningoencephalitis.
BACKGROUND
Pituitary apoplexy, a rare but life-threatening disorder, is characterized by the abrupt destruction of pituitary tissue secondary to infarction or hemorrhage of the gland itself. Its clinical features include severe headache, stiff neck, fever, visual disturbances, and symptoms of hypoadrenalism.


OBJECTIVE
To assess how pituitary apoplexy may mimic the clinical findings of an infectious meningoencephalitis.


RESULTS
We describe 3 individuals whose clinical profile and paraclinical studies were consistent with a diagnosis of presumed infectious meningoencephalitis. With minimal improvement on antimicrobial therapy, however, an extensive clinical and radiographic reevaluation yielded pituitary apoplexy as the etiology of their acute neurologic event.


CONCLUSIONS
Pituitary apoplexy is often misdiagnosed as meningitis or subarachnoid hemorrhage due to the presence of leukocytes and erythrocytes in the cerebrospinal fluid. These cases serve to highlight the importance of maintaining a broad differential diagnosis when evaluating patients presenting with an acute headache.
Section of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Davinder S
DS
Jassal
Gregory
G
McGinn
John M
JM
Embil
D000208:Acute Disease; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008590:Meningoencephalitis / Q000175:diagnosis*; D008875:Middle Aged; D010899:Pituitary Apoplexy / Q000175:diagnosis* / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis