Endocrine Abstracts

Background: Pituitary apoplexy is a rare clinical syndrome, caused by hemorrhagic or ischemic necrosis of the pituitary gland. It is often associated with an existing pituitary adenoma, especially nonfunctioning tumors. Pituitary apoplexy may mimic the clinical findings of an infectious meningoencephalitis.

Case report: A 57-year-old man was admitted to the emergency department following sudden onset of severe headaches, fever, chills, and signs of meningeal syndrome, associated with unilateral ptosis, mydriasis and diplopia. His medical history included arterial hypertension, diabetes mellitus and epilepsy. Blood test revealed a high CRP at 403 mg/l with a white blood count of 11600/mm3. A lumbar puncture was performed, revealing a hyperleukocytosis with a polymorphonuclear predominance at 87%, proteinorachy of 0.93 g/dl, without glycorachy, raising the suspicion of meningitis. The MRI scan demonstrated a 24 x 20 x 27 mm pituitary mass, extending upwards into the suprasellar cistern and compressing the optic chiasm, images consistent with haemorrhage into a pre-existing pituitary macroadenoma. The patient underwent transsphenoidal surgery. Histopathology examination confirmed the diagnosis of pituitary adenoma with apoplexy and inflammation, and microbiologic examination was positive for Staphylococcus Aureus and Staphylococcus Capitis. The post-surgery endocrine workup showed a deficiency of the thyrotropic and gonadotropic axes, a partial deficiency of the corticotrope axis and a moderate increase in prolactin level.

Conclusion: We hypothesize that either there was an underlying inflammatory pathology due to Staphylococcus infection that contributed to the development of pituitary apoplexy, or the presence of necrosis and haemorrhage at that level represented the departure point for the infection. Surgical intervention should urgently be performed when there is a compression of the optic chiasm.

Key words: pituitary apoplexy, infection, macroadenoma