Endocrine Abstracts

Introduction: Transsphenoidal surgery is the preferred approach in patients with pituitary tumours. Transsphenoidal resection of pituitary tumors may account for as much as 20% of all intracranial operations performed for primary brain tumors. Meningitis is a rare complication accounting for less than 2% of procedures.

Methods: We report the case of an elderly patient with a sellar mass who was admitted to the hospital with a central nerve system infection 15 days after brain surgery (transsphenoidal resection).

Results: We present the case of a 77 years old woman with no personal history of interest except for primary hypothyroidism in treatment with 50 mcg of L-thyroxine, who was diagnosed of a sellar mass of 4.5 cm as she was being studied for headache and severe visual loss. This lesion was compatible with a macroadenoma with suprasellar extension with mass effect on optic chiasm. No campimetry could be performed due to severe visual impairment. Hormonal evaluation showed mild-moderate elevation of prolactin (86.9 ng/ml; Normal range 10-30), probably related to pituitary stalk compression, moderate elevation of gonadotropins considering her postmenopausal state (LH 9 μU/ml; FSH 24 9 μU/ml), undetectable levels of IGF-1 and normal levels of cortisol and thyroid hormones. With the diagnosis of pituitary macroadenoma of 4.5 cm with optic chiasm compression and 2 pituitary axis affected (somatotropic and gonadotropic axis) she underwent transsphenoidal resection of the tumour. Inmediately after surgery cortisol and free thyroid hormones levels decreased and she was discharge of hospital with hydrocortisone 30 mg per day and L-Thyroxine 88 mcg per day. 15 days after surgery our patient was admitted to the hospital with headache, confusion and disorientation. No other neurological focal signs were found. A lumbar puncture showed 5440 leukocytes/μL (98% polymorponuclear); glucose 1 mg/dl and proteins 180 mg/dl indicating a bacterial infection, however, no microbiological findings were seen on CSF cultures. After 15 days of treatment with Meropenem, Vancomicyn and Ampicilin our patient recovered completely and was discharged with her usual substitution treatment. She had not presented any other complications so far.

Conclusion: Transsphenoidal surgery is the most common approach for removing pituitary adenomas. Meningitis is a rare complication of this technique but we must consider it in those patients who present with neurological signs, fever or headache after pituitary surgery.