title: Spontaneous remission of acromegaly: apoplexy mimicking meningitis or meningitis as a cause of apoplexy?
abstract: Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome characterized by ischemic infarction or hemorrhage into a pituitary tumor. The diagnosis of pituitary tumor apoplexy is frequently complicated because of the nonspecific nature of its signs and symptoms, which can mimic different neurological processes, including meningitis. Several factors have been associated with apoplexy, such as dopamine agonists, radiotherapy, or head trauma, but meningitis is a rarely reported cause. We describe the case of a 51-year-old woman with acromegaly due to a pituitary macroadenoma. Before surgical treatment, she arrived at Emergency with fever, nausea, vomiting and meningismus. Symptoms and laboratory tests suggested bacterial meningitis, and antibiotic therapy was initiated, with quick improvement. A computerized tomography (CT) scan at admission did not reveal any change in pituitary adenoma, but a few weeks later, magnetic resonance imaging (MRI) showed data of pituitary apoplexy with complete disappearance of the adenoma. Currently, her acromegaly is cured, but she developed hypopituitarism and diabetes insipidus following apoplexy. We question whether she really experienced meningitis leading to apoplexy or whether apoplexy was misinterpreted as meningitis. In conclusion, the relationship between meningitis and pituitary apoplexy may be bidirectional. Apoplexy can mimic viral or bacterial meningitis, but meningitis might cause apoplexy, as well. This fact highlights the importance of differential diagnosis when evaluating patients with pituitary adenomas and acute neurological symptoms.
authors.affiliation: Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: Villar-Taibo
authors.affiliation: Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: María D
authors.initials: MD
authors.lastname: Ballesteros-Pomar
authors.affiliation: Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Vidal-Casariego
authors.affiliation: Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Alvarez-San Martín
authors.affiliation: Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: Georgios
authors.initials: G
authors.lastname: Kyriakos
authors.affiliation: Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
authors.forename: Isidoro
authors.initials: I
authors.lastname: Cano-Rodríguez
mesh_terms: D000172:Acromegaly / Q000209:etiology* / Q000473:pathology; D000236:Adenoma / Q000378:metabolism*; D003919:Diabetes Insipidus / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D019382:Human Growth Hormone / Q000378:metabolism*; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology; D008279:Magnetic Resonance Imaging; D016920:Meningitis, Bacterial / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D009365:Neoplasm Regression, Spontaneous; D010899:Pituitary Apoplexy / Q000175:diagnosis* / Q000209:etiology; D010911:Pituitary Neoplasms / Q000378:metabolism*; D012075:Remission, Spontaneous; D014057:Tomography, X-Ray Computed
chemical_list: D019382:Human Growth Hormone