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A case of pituitary apoplexy mimicking viral meningitis

Pituitary apoplexy (PA) is a clinical syndrome caused by ischemia or hemorrhage of the pituitary gland, typically in the context of an adenoma. It typically presents with a thunderclap headache and sterile cerebral spinal fluid (CSF). The authors identify a case of PA, which initially presented with...

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Autores principales: Lally, Anne, Funari, Abigail, Ghosh, Sayak R., Karandish, Alireza, Ledet, Alexander J., Agarwal, Vijay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10129182/
https://www.ncbi.nlm.nih.gov/pubmed/37113836
http://dx.doi.org/10.1097/MS9.0000000000000323
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author Lally, Anne
Funari, Abigail
Ghosh, Sayak R.
Karandish, Alireza
Ledet, Alexander J.
Agarwal, Vijay
author_facet Lally, Anne
Funari, Abigail
Ghosh, Sayak R.
Karandish, Alireza
Ledet, Alexander J.
Agarwal, Vijay
author_sort Lally, Anne
collection PubMed
description Pituitary apoplexy (PA) is a clinical syndrome caused by ischemia or hemorrhage of the pituitary gland, typically in the context of an adenoma. It typically presents with a thunderclap headache and sterile cerebral spinal fluid (CSF). The authors identify a case of PA, which initially presented with the signs and symptoms of viral meningitis. PRESENTATION OF CASE: A 44-year-old man presented to the emergency department with headache, nuchal rigidity, fever, and delirium. The patient reported a 10-year history of chronic that were partially responsive to acetaminophen. Four days after admission, the patient developed right-sided cranial nerve III, IV, and VI palsies. Labs revealed anemia and hyponatremia. The CSF was leukocytic, lymphocyte-predominant, and had elevated protein. In addition to these results, negative CSF bacterial cultures led the care team to believe this case was viral meningoencephalitis. Routine MRI of the brain at presentation revealed a 3.1×2.5×3.2 (craniocaudal×anterior posterior×transverse) expansile mass centered within the sella turcica. An endocrine workup revealed hypopituitarism. The diagnosis of PA was then made. A microscopic transsphenoidal resection of the sellar mass was performed, and histopathologic analysis confirmed necrotic pituitary adenoma tissue. Following an uncomplicated procedure, the patient recovered fully from his cranial nerve palsies and continues to do well. DISCUSSION: Because life-threatening hypotension from acute adrenal insufficiency can be caused by PA, timely diagnosis is crucial. When a patient presents with meningism, PA should be included in the differential diagnosis. CONCLUSION: This report illustrates a case of PA presenting with symptoms and a CSF profile classically associated with viral meningitis.
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spelling pubmed-101291822023-04-26 A case of pituitary apoplexy mimicking viral meningitis Lally, Anne Funari, Abigail Ghosh, Sayak R. Karandish, Alireza Ledet, Alexander J. Agarwal, Vijay Ann Med Surg (Lond) Case Reports Pituitary apoplexy (PA) is a clinical syndrome caused by ischemia or hemorrhage of the pituitary gland, typically in the context of an adenoma. It typically presents with a thunderclap headache and sterile cerebral spinal fluid (CSF). The authors identify a case of PA, which initially presented with the signs and symptoms of viral meningitis. PRESENTATION OF CASE: A 44-year-old man presented to the emergency department with headache, nuchal rigidity, fever, and delirium. The patient reported a 10-year history of chronic that were partially responsive to acetaminophen. Four days after admission, the patient developed right-sided cranial nerve III, IV, and VI palsies. Labs revealed anemia and hyponatremia. The CSF was leukocytic, lymphocyte-predominant, and had elevated protein. In addition to these results, negative CSF bacterial cultures led the care team to believe this case was viral meningoencephalitis. Routine MRI of the brain at presentation revealed a 3.1×2.5×3.2 (craniocaudal×anterior posterior×transverse) expansile mass centered within the sella turcica. An endocrine workup revealed hypopituitarism. The diagnosis of PA was then made. A microscopic transsphenoidal resection of the sellar mass was performed, and histopathologic analysis confirmed necrotic pituitary adenoma tissue. Following an uncomplicated procedure, the patient recovered fully from his cranial nerve palsies and continues to do well. DISCUSSION: Because life-threatening hypotension from acute adrenal insufficiency can be caused by PA, timely diagnosis is crucial. When a patient presents with meningism, PA should be included in the differential diagnosis. CONCLUSION: This report illustrates a case of PA presenting with symptoms and a CSF profile classically associated with viral meningitis. Lippincott Williams & Wilkins 2023-03-27 /pmc/articles/PMC10129182/ /pubmed/37113836 http://dx.doi.org/10.1097/MS9.0000000000000323 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Case Reports
Lally, Anne
Funari, Abigail
Ghosh, Sayak R.
Karandish, Alireza
Ledet, Alexander J.
Agarwal, Vijay
A case of pituitary apoplexy mimicking viral meningitis
title A case of pituitary apoplexy mimicking viral meningitis
title_full A case of pituitary apoplexy mimicking viral meningitis
title_fullStr A case of pituitary apoplexy mimicking viral meningitis
title_full_unstemmed A case of pituitary apoplexy mimicking viral meningitis
title_short A case of pituitary apoplexy mimicking viral meningitis
title_sort case of pituitary apoplexy mimicking viral meningitis
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10129182/
https://www.ncbi.nlm.nih.gov/pubmed/37113836
http://dx.doi.org/10.1097/MS9.0000000000000323
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