Endocrine Abstracts

Background: Meningitis coexisting with pituitary macroadenoma is rarely observed. It occurs either as a primary meningitis (primary tumor manifestation), or as a secondary meningitis (after neurosurgery or reduction of the volume of the tumor which has destroyed the sellar floor or the skull base).

Objective: Case reports of two patients with the concomitance of secondary meningitis and pituitary macroadenoma.

Case 1: A 36-year-old man treated with dopamine agonist because of hyperprolactinemia due to pituitary macroadenoma. In MRI a solid tumor mass with cystic components (2.6×3.7×3.6 cm) was described. Hyperprolactinemia and partial hypopituitarism (adrenal, thyroid and gonadal insufficiency) were present. After 1 year of treatment, partial tumor regression, PRL normalization and improvement of pituitary function were observed. During the 3rd year of the illness purulent meningitis was diagnosed with a subsequent complete loss of pituitary function. MRI showed a cystic sellar mass (3.0×2.9×3.2 cm) with ring, intense, irregular, peripheral enhancement after a contrast injection. A transsphenoidal excision was done. Post-surgical study revealed the pituitary abscess.

Case 2: A 42-year-old woman with acromegaly diagnosed 8 years earlier. In MRI a giant adenoma (5.5×3.7×3.2 cm) spreading to cavernous sinuses, sphenoid sinus and suprasellar region was certified. The patient received somatostatin analogue and 1 year later she underwent partial transsphenoidal adenomectomy. A postoperative pathologic examination revealed pituitary adenoma: GH(+++) and PRL(+++). After neurosurgery somatostatin analogue and bromocriptine were continued. Four years later the patient was admitted to hospital due to purulent meningitis. After the meningitis healing the tumor size and pituitary function remained unaffected.

Conclusions: Despite the fact that meningitis coexisting with pituitary macroadenoma is rare, we should remember that it can occur both before and after neurosurgery. It may result in a full recuperation or in aggravation of earlier endocrine disturbances with a specific complication such as a pituitary abscess.