title: Brain abscess as the initial presentation of a macroprolactinoma: Case report.
abstract: Macroprolactinomas may behave invasively and infiltrate the skull base, causing a subsequent thinning that can also lead to a bone defect and a direct route of entry for pathogens. We describe the case of a 34-year-old male admitted to hospital with fever (38°C), headache, stiffness in the neck, diplopia and neurological impairment. Brain magnetic resonance imaging showed two bilateral abscesses in the fronto-parietal areas with intracranial venous sinus thrombosis and a pituitary adenoma that extended from the suprasellar region, eroding the sellar floor into the sphenoid sinus. Laboratory hormone measurements showed increased levels of prolactin and low levels of FSH, LH and testosterone. The patient received antibiotic treatment and surgery was performed. The patient developed central deafness as a neurological deficit. It is advisable to include pituitary adenoma in the differential diagnosis of meningitis even though its onset as intracranial abscess and rectus sinus thrombosis is extremely rare.
authors.affiliation: Department of Endocrinology, Hospital Universitario y Politécnico La Fe, Valencia, Spain. Electronic address: matirubal@gmail.com.
authors.forename: Matilde
authors.initials: M
authors.lastname: Rubio-Almanza
authors.affiliation: Department of Endocrinology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Cámara-Gómez
authors.affiliation: Department of Neurosurgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Laila Pérez
authors.initials: LP
authors.lastname: de San Román-Mena
authors.affiliation: Department of Neurosurgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Simal-Julián
authors.affiliation: Department of Endocrinology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Ramos-Prol
authors.affiliation: Department of Neurosurgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Botella-Asunción
authors.affiliation: Department of Endocrinology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Merino-Torres
mesh_terms: D000328:Adult; D001922:Brain Abscess / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008297:Male; D010911:Pituitary Neoplasms / Q000150:complications*; D015175:Prolactinoma / Q000150:complications*
keywords: Absceso cerebral; Adenoma hipofisario; Brain abscess; Cirugía transesfenoidal; Meningitis; Pituitary adenoma; Prolactinoma; Rectus sinus thrombosis; Transsphenoidal surgery; Trombosis del seno recto