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Endocrine Abstracts (2013) 32 P237 | DOI: 10.1530/endoabs.32.P237

ECE2013 Poster Presentations Clinical case reports – Pituitary/Adrenal (57 abstracts)

Suppurative meningitis as a life threatening primary presentation of macroprolactinomas

Lina Akkache , Katia Daffeur , Nadia Kalafate , Meriem Haddad & Farida Chentli

Department of Endocrine and Metabolic Diseases, Bab Oued Hospital, Algiers, Algeria.

Introduction: Suppurative meningitis (SM) is a life threatening disease. It is rarely observed as a primary presentation in large pituitary tumours (PT) destroying the sellar floor and/or invading the skull base. Our aim is to report 3 SM revealing macroprolactinomas.

Case No. 1: A man aged 22, consulted for vomiting and fever. The diagnosis of SM was confirmed by lumbar puncture and blood cultures. Cerebral MRI showed multidirectional PT invading cavernous sinuses. Hormonal assessment demonstrated high prolactin with pituitary deficits (PD). After antibiotics SM was sterilized. Then, the PT was treated with dopamine agonists that were successful on prolactin and tumour size. The SM never relapsed, although the sellar floor was not surgically repaired.

Case No. 2: A male aged 49 hospitalized for the fourth bacterial SM episodes. Cerebral MRI showed an invasive and multi directional PT. The SM was cured by antibiotics. Prolactin was normalized by bromocriptine and the tumour size was significantly reduced. There was not any SM relapse.

Case No. 3: A man aged 25, with a history of arrested puberty, diagnosed as having a macro-prolactinoma, with supra, infra and latero-sellar expansions revealed by a SM due to pneumococcal infection. The SM was sensitive to antibiotics, prolactin normalized under bromocriptine and tumour volume decreased progressively. There was not any relapsing.

Conclusion: Primary SM (PSM) rarely reveals PT, except if this one is very aggressive. To our knowledge only 52 cases have been reported. PSM can precede cerebrospinal leak which should be treated by surgery to avoid life threatening complications.

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