Abstract
We report a case of pituitary apoplexy (PA) with negative radiographic findings for PA and cerebrospinal fluid (CSF) analysis consistent with neutrophilic meningitis. PA is a rare endocrinopathy requiring prompt diagnosis and treatment. Presentation with acute neutrophilic meningitis is uncommon. The diagnostic modalities included pituitary function tests (adrenocorticotropic hormone, thyroid-stimulating hormone, luteinizing hormone, prolactin), brain computed tomography and magnetic resonance imaging (MRI), and CSF analysis. A 67-year-old man presented with worsening headache, nausea, and retching. He was somnolent with an overall normal neurologic examination other than a peripheral vision defect in the left eye. MRI showed a pituitary mass bulging into the suprasellar cistern with optic chiasm elevation, consistent with pituitary macroadenoma. Laboratory evaluation revealed decreased levels of adrenocorticotropic hormone, random cortisol, thyroid-stimulating hormone, thyroxine, luteinizing hormone, and testosterone. He had worsening encephalopathy with left eye ptosis and decreased vision, prompting a repeat computed tomography and MRI, showing no interval change in the pituitary adenoma or evidence of bleeding. CSF analysis...Continue Reading
References
May 1, 1990·Journal of Neurology, Neurosurgery, and Psychiatry·J B Winer, G Plant
Sep 1, 1999·Clinical Endocrinology·H S RandevaJ A Wass
Sep 19, 2001·Journal of Neurology, Neurosurgery, and Psychiatry·V BiousseN M Oyesiku
Dec 13, 2003·Journal of Endocrinological Investigation·M ValenteF Santeusanio
Feb 26, 2004·Headache·Davinder S JassalJohn M Embil
Jun 9, 2004·Lancet·R C W MaC S Cockram
Dec 20, 2007·Neurosurgery·Patrick L SempleEdward R Laws
Mar 29, 2008·Journal of Intensive Care Medicine·Rita N NawarBaha M Arafah
Jun 27, 2009·The American Journal of Emergency Medicine·Wen-Yi HuangHsien-Chih Chen
Oct 7, 2011·International Journal of Emergency Medicine·Ahmed-Ramadan SadekThiagarajan Jaiganesh
Jun 7, 2014·Brain Tumor Research and Treatment·Keun OhSe-Hyuk Kim
Oct 16, 2014·Insights Into Imaging·Alessandro BoellisAlessandro Bozzao
Apr 11, 2015·Journal of Neurosurgery·Tarun D SinghAlejandro A Rabinstein
Sep 29, 2015·Endocrine Reviews·Claire BrietPhilippe Chanson
Jan 12, 2017·International Journal of Endocrinology·Adriana AlbaniSalvatore Cannavò
Aug 25, 2018·Endocrine Connections·Ali AbbaraNiamh M Martin