Endocrine Abstracts

The spectrum of lesions in the sellar and parasellar region includes a wide range of diseases, from the most common adenoma to various non-adenomatous lesions i.a. empty sella syndrome, stroke and congenital conditions. We identified a case of meningitis in which the images initially suggested the presence of a pituitary macroadenoma. The 45-year-old patient without chronic diseases was admitted to the Department of Neurology due to severe headaches and vomiting that had woken him up the night before. Neurological examination showed no signs of focal CNS damage, meningeal symptoms were negative. A non-contrast CT brain revealed in the sellar region a heterogeneous, hypodense lesion 18x18mm. The diagnostics were extended to head MR which showed a mass in the sella 22x19x19mm, with a heterogeneous high signal, intensity, focally in the central and slightly peripheral part, enhanced after contrast administration. A suspicion of pituitary macroadenoma or Rathke’s pouch was made. Additionally, the image of dura mater suggested meningitis and inflammatory changes in the nasal sinuses. CSF analysis revealed lymphocytic or viral meningitis. The patient reported the deterioration of vision in the right eye and the temporal disturbances in visual field examination in this eye were confirmed. Blood tests revealed increased inflammatory markers, intravenous antibiotics were initiated, leading to a favourable clinical outcome. Initial analysis of pituitary function revealed normal low morning cortisol concentration (166nmol/l) with a normal ACTH concentration (25.7 pg/ml) preserved other pituitary axes, however, the supplementation of the hydrocortisone has been implemented. The patient was referred to our department. Pituitary MR was performed which confirmed previous intrasellar and parasellar meningitis, complicated by bleeding into the encapsulated space in the sella and post-hemorrhagic areas in the suprasellar and intrasellar region; intrasellar lesions had decreased from 21mm to 5mm. The sellar diaphragm remained in post-inflammatory conglomerates with the optic chiasm, which remained deformed and pulled strongly downwards. The optic chiasm showed a heterogeneous increase in T2 weighted signal. In this situation, there were no indications for neurosurgery. In subsequent follow-up imaging examinations, further regression of the sellar region lesions occurred, with no progression in the involvement of the optic nerves. This case illustrates an atypical type of meningitis mimicking a pituitary macroadenoma. This proves that due to the complex nature of pituitary diseases, most patients require coordinated care. It shows the need for an integrated, multidisciplinary approach to the diagnosis, assessment and treatment of patients with pituitary disorders.