Pituitary Apoplexy Mimicking Infectious Meningitis: A Case Report

Yang-Ming Lee ； Shi-Dou Lin ； Hon-Ke Sia ； Wei-Liang Chen ； Shang-Ren Hsu

《Formosan Journal of Endocrinology and Metabolism》 2卷2期 (2011/04) Pp. 49-54

https://doi.org/10.6856/FJEM.201104_2(2).0004

摘要

Pituitary apoplexy is an unusual disorder that remains underdiagnosed and is therefore sometimes treated inappropriately. It often results from hemorrhage or infarction of a pre-existing pituitary adenoma. Onset is frequently accompanied by a sudden increase in intrasellar content or pressure, causing compression of the normal pituitary gland and adjacent neurovascular structures (eg, cranial nerves III, IV, V, and VI), resulting in severe headache, pituitary insufficiency, impaired consciousness, visual disturbance and ophthalmoplegia. Signs of meningeal irritation are not common and generally not considered typical of pituitary apoplexy. Thus, if the patient presents with acute headache accompanied by meningism, pituitary apoplexy may be overlooked. We describe a 68-year-old man who presented with acute headache, fever, neck stiffness and alteration of consciousness. Cerebrospinal fluid showed neutrophilic pleocytosis, increased protein level and decreased glucose concentration. Antibiotic was administered for presumed bacterial meningitis, but he responded poorly to treatment. Magnetic resonance imaging (MRI) of the brain later revealed a pituitary adenoma with recent hemorrhage. Endocrinologic studies indicated panhypopituitarism. After receiving appropriate hormonal replacement therapy, the patient recovered.

關鍵字

Hypopituitarism ； Meningitis ； Pituitary adenoma ； Pituitary apoplexy