Pituitary Apoplexy Masquerading as Meningoencephalitis

Authors

  • Davinder S. Jassal MD, FRCPC,

    1. From the Section of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia (Dr. Jassal) and the Sections of Neuroradiology (Dr. McGinn) and Infectious Diseases (Dr. Embil), University of Manitoba, Winnipeg; Canada.
    Search for more papers by this author
  • Gregory McGinn MD, FRCPC,

    1. From the Section of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia (Dr. Jassal) and the Sections of Neuroradiology (Dr. McGinn) and Infectious Diseases (Dr. Embil), University of Manitoba, Winnipeg; Canada.
    Search for more papers by this author
  • John M. Embil MD, FRCPC

    1. From the Section of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia (Dr. Jassal) and the Sections of Neuroradiology (Dr. McGinn) and Infectious Diseases (Dr. Embil), University of Manitoba, Winnipeg; Canada.
    Search for more papers by this author

Address all correspondence to Dr. Davinder S. Jassal, Department of Cardiology, Queen Elizabeth II Health Sciences Centre, Room 2134-1796, Summer Street, Halifax, Nova Scotia B3K 6A3, Canada.

Abstract

Background.—Pituitary apoplexy, a rare but life-threatening disorder, is characterized by the abrupt destruction of pituitary tissue secondary to infarction or hemorrhage of the gland itself. Its clinical features include severe headache, stiff neck, fever, visual disturbances, and symptoms of hypoadrenalism.

Objective.—To assess how pituitary apoplexy may mimic the clinical findings of an infectious meningoencephalitis.

Methods and Results.—We describe 3 individuals whose clinical profile and paraclinical studies were consistent with a diagnosis of presumed infectious meningoencephalitis. With minimal improvement on antimicrobial therapy, however, an extensive clinical and radiographic reevaluation yielded pituitary apoplexy as the etiology of their acute neurologic event.

Conclusion.—Pituitary apoplexy is often misdiagnosed as meningitis or subarachnoid hemorrhage due to the presence of leukocytes and erythrocytes in the cerebrospinal fluid. These cases serve to highlight the importance of maintaining a broad differential diagnosis when evaluating patients presenting with an acute headache.

Ancillary