A 75-year-old man presented to Emergency department with fever and 3 episodes of tonic clonic seizures. He had recent ear infection. He was intubated and ventilated and taken to ICU.
He had CT head which was normal. Lumbar puncture results were consistent with Pneumococcal meningitis. He was treated with appropriate antibiotics.
During recovery he had persistent hyponatremia. He was reviewed by Endocrine team and his TFT, cortisol and other pituitary hormones were normal. His repeat CT head was normal. Further investigations confirmed SIADH possibly secondary to meningitis.
He presented to the GP 8 months later, with increasing tiredeness and lethargy. Investigations showed testostrone was 0.4 nmol/l, FSH 2 U/l and LH1 U/l. His TSH was 1.92 mU/l with free T4 7.5 pmol/l. His cortisol was 120 nmol/l and prolactin was 471 mU/l.
He was reviewed in the Endocrine clinic and Basal pituitary function test and Glucagon stimulaton test were arranged.
|TSH||1.66 mU/l (0.56 mU/l)|
|FT4||6 pmol/l (925 pmol/l)|
|Cortisol||230 nmol/l (280700 nmol/l)|
|LH||1 U/l (38 U/l)|
|FSH||2 U/l (0.55 U/l)|
|Testosterone||1.6 nmol/l (942 noml/l)|
|Prolactin||392 mU/l (<450 mU/l)|
|IGF1||25 nmol/l (59177 nmol/l)|
His GST showed flat cortisol response with peak of 293, confirming cortisol deficiency and GH peak was only < 0.3 mU/l confirming GH deficiency.
His MRI pituitary showed Empty sella with no evidence of intra sellar mass or Haemorrhage.visual fields were normal.
He was commenced on Hydrocortisone replacement follwed by Thyroxine and Testosterone replacement. His energy levels had improved and patient felt much better. Now he is under regular endocrine follow up.
Hypopituitarism is a well recognised and rare complication of bacterial meningitis and only few cases have been reported in the literature. Endocrinologist should be aware of this potential complication of meningitis.