Endocrine Abstracts

Introduction: The classical revealing manifestations of a pituitary adenoma are represented by the combination of a tumor syndrome and endocrine syndrome. The occurrence of meningoencephalitis as a mode of revelation of a macroadenoma is exceptional.

Case: Mr. M.O, 36 years old, with no significant medical history, brutally presented severe headaches, vomiting, behavioral disorder with fever and bilateral decreased visual acuity. On examination, the patient was conscious, febrile to 39.8 with nuchal rigidity. At presentation: leukocytosis at 18 000/m3, a C-reactive protein at 69 mg/l. The head CT scan showed bilateral areas of hypo density with Intra-and suprasellar invasive lesional process. The magnetic resonance imaging showed a pituitary macroadenoma 30×32 mm invading the sphenoid sinus, the right cavernous sinus and elevating the optic chiasm. The cerebrospinal fluid analysis showed a lymphocytic liquid with elevated protein and normal glucose level. Culture was negative as well as herpes simplex virus PCR. The biological analysis of endocrine hormones balance objectived a pan hypopanpituitarisme insufficiency. The patient received ceftriaxone, acyclovir, replacement therapy and was scheduled for surgery.

Discussion: Meningoencephalitis is a rare presentation as first manifestation of macroadenoma. In literature, only three cases of Meningoencephalitis were reported as revealing macroadenomas. We illustrate this observation through an unusual and serious form of revelation of a macroadenoma.