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Case Report
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| Pituitary apoplexy resembling acute meningitis without visual defect and ophthalmoplegia |
| Shu-Yi Wang1, Chieh-Sen Chuan2, 3 |
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1Departments of Endocrinology and Metabolism, Changhua Christian Hospital, Changhua, Taiwan.
2Departments of Neurology, Changhua Christian Hospital, Changhua, Taiwan. 3Department of Life Sciences, National Chung-Hsing University, Taichung City, Taiwan. |
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doi:10.5348/ijcri-2012-07-146-CR-7
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Address correspondence to: Chieh-Sen Chuang, MD Department of Neurology, Changhua Christian Hospital Changhua, Taiwan. No. 135, Nanxiao St., Changhua City Changhua County 500 Taiwan Email: Email: 83954@cch.org.tw |
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| How to cite this article: |
| Wang SY, Chuang CS. Pituitary apoplexy resembling acute meningitis without visual defect and ophthalmoplegia. International Journal of Case Reports and Images 2012;3(7):26–29. |
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Abstract
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Introduction:
Pituitary apoplexy is a rare but life-threatening disorder. The clinical presentation includes severe headache, impaired consciousness, fever, visual disturbances, variable ocular paresis and hypoadrenalism. It usually results from sudden hemorrhage or infarction-induced swelling in a pituitary adenoma. Signs of meningeal irritation are very rare. The presentation of headache, fever, pleocytosis and meningism might lead to a misdiagnosis of septic meningitis.
Case Report: We described a 71-year-old man who suffered from acute headache, fever, chills, dizziness and photophobia. Stiffness in the neck was notable and the cerebrospinal fluid study revealed neutrophilic pleocytosis. Empiric antibiotic therapy was administered for suspected septic meningitis but the symptoms persisted. Further brain imaging study showed pituitary adenoma with recent hemorrhage and the endocrine survey revealed a low cortisol level. Corticosteroid was added for pituitary apoplexy, and the patient recovered without surgical management. Conclusion: When a patient presents with fever, headache and meningeal irritation, it is important to include pituitary apoplexy in the differential diagnosis of infectious meningitis. Early treatment of pituitary apoplexy allows for aggressive endocrine management or neurosurgical decompression when required. | |
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Key Words:
Pituitary Apoplexy, Meningitis, Hypoadrenalism, Pituitary adenoma
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Author Contributions:
Shu-Yi Wang - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Chieh-Sen Chuang - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission:
The corresponding author is the guarantor of submission. |
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Source of support:
None |
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Conflict of interest:
Authors declare no conflict of interest. |
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Copyright:
© Shu-Yi Wang et al. 2012; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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