Endocrine Abstracts

Introduction: Infectious diseases of the central nervous system (CNS) have been associated with hypopituitarism which relates to the severity, the localization and the cause of the infection. We present here a case of a CNS abscess and hormone deficiencies. A 53 years old man referred to the emergency department of our hospital with high fever and confusion and a 3 day history of weakness and anorexia. On clinical examination he was febrile (38.4^oC), disoriented in time and place, and slightly lethargic. He had ophthalmoplegia, eyelid ptosis, mydriasis and non reactive pupil of the right eye and no other significant findings. Investigations revealed increased white blood cells count, C- Reactive Protein and Erythrocyte Sedimentation Rate. A brain MRI showed a lesion in the sphenoid and cavernous sinus, expanding to the sellar and hypersellar region and retrobulbar oedema in the right eye and he was commenced on intravenous antibiotics. A laboratory evaluation of his pituitary function was performed, which reveal hypopituitarism (Cortisol =1,8 μ g/dl, ACTH =4 pg/ml, FSH =2.41 mIU/ml, LH =0.29 mIU/ml, Testo =0.389 ng/ml, TSH =0.08 μIU/ml, FT4=0.83 ng/dl, IGF-1=56 ng/ml (71–284 for his age)) and the patient was put on hormonal replacement therapy with hydrocortisone, thyroxin and testosterone. A transphenoidal approach to the lesion at the sphenoid sinus was performed a few days later and the diagnosis of the cerebral abscess was made, but no pathogens were found, probably because he was already receiving antibiotics. On the 9^th day on antibiotics he was apyrexial, alert with no confusion. Six months later he was still on oral antibiotics, clinically well, with great improvement of his MRI brain findings, but he was still requiring hormone replacement.

Conclusions: Hypopituitarism due to cerebral abscess is rare, can occur at an early or a late stage and can be either transient or permanent. Its diagnosis may be difficult, demands great suspicion and these patients need a long term follow up.