Brain Tumor Res Treat.  2013 Oct;1(2):111-115. 10.14791/btrt.2013.1.2.111.

Pituitary Apoplexy Mimicking Meningitis

• Oh K
• Kim JH
• Choi JW
• Kang JK
• Kim SH

• KMID: 2048486
• DOI: http://doi.org/10.14791/btrt.2013.1.2.111

Abstract

Pituitary apoplexy is a rare but life-threatening disorder. Clinical presentation of this condition includes severe headaches, impaired consciousness, fever, visual disturbance, and variable ocular paresis. The clinical presentation of meningeal irritation is very rare. Nonetheless, if present and associated with fever, pituitary apoplexy may be misdiagnosed as a meningitis. We experienced a case of pituitary apoplexy masquerading as a meningitis. A 42-year-old man presented with meningitis associated symptoms and initial imaging studies did not show evidence of intra-lesional hemorrhage in the pituitary mass. However, a follow-up imaging after neurological deterioration revealed pituitary apoplexy. Hereby, we report our case with a review of literatures.

Keyword

Pituitary apoplexy; Meningitis

MeSH Terms

Adult
Consciousness
Fever
Follow-Up Studies
Headache
Hemorrhage
Humans
Meningitis*
Paresis
Pituitary Apoplexy*

Figure

• 

  Fig. 1 Non-contrast brain computed tomography scans show a 2.0×1.5 cm sized isodense sellar mass (A), without evidence of intralesional or subarachnoid hemorrhage (B).

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  Fig. 2 Initial sellar magnetic resonance imaging findings. T2-weighted axial image shows a sellar mass with heterogenous internal high intensity signals (A). Non-contrast T1-weighted sagittal and coronal images show a pituitary mass extending suprasellar area without typical findings compatible with intralesional hemorrhage (B and C) and contrast enhanced coronal image show a pituitary mass with peripheral enhancement (D).

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  Fig. 3 Follow-up brain magnetic resonance imaging findings. T2-weighted axial image shows mixed signal intensity of pituitary mass (A). Non-contrast T1-weighted sagittal and axial images show peripheral high signal intensity of pituitary mass (B and C). Gradient-echo T2-weighted axial image shows multiple low signal intensities suggesting intralesional hemorrhage (D).

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  Fig. 4 Histopathologic findings from specimens of the pituitary tumor. Hematoxylin and eosin staining is demonstrating the hemorrhagic necrosis of pituitary gland consistent with pituitary apoplexy (A: ×10 magnification) and pituitary adenoma showing necrotic degeneration with hemorrhage (B: ×200 magnification).

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