A Case Report of Cure of Acromegaly after Pituitary Apoplexy

Pituitary apoplexy is a rare life threatening condition. Clinical manifestation cause acute severe headache, fever, impaired conscious level, ocular palsies, visual disturbance and signs of meningeal irritation. Presentation can mimic and misdiagnosed as meningitis. Here, we report a 33-year- old man who was suspected to have pituitary macroadenoma causing acromegaly due to clinical features and high IGF-1. He presented with severe headache, fever, impaired conscious level, and left ocular palsy. Laboratory data showed leukocytosis and neutrophils pleocytosis in cerebrospinal fluid. Bacterial meningitis was suspected, so he was kept on antibiotics and dexamethasone with quick improvement. Magnetic resonance imaging showed necrotic pituitary macroadenoma and laboratory test confirmed resolution of acromegaly, which was confirmed by normalization of IGF-1 and was kept on Octerotide. He was remained hypopituitarism and kept on replacement. On further follow up, MRI showed marked regression of pituitary adenoma. Whether he really had meningitis which lead to apoplexy or it was pituitary apoplexy mimicking meningitis is questionable. There is a bidirectional relationship between pituitary apoplexy and meningitis. This case adds the importance fact of keeping the differential diagnosis in mind in patients with pituitary adenoma who presents with acute neurological symptoms.

Author(s): Husain Taha Rhadi*, Ebtihal Yusuf and Eman Ebrahim

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