Endocrine Abstracts

JOINT838

Introduction: The most frequent clinical manifestations of sellar craniopharyngiomas are endocrinological disturbances or symptoms from masse effect such as visual impairment, headache, and rarely signs of intracranial hypertension. However, rare cases in the literature have been described mimicking a febrile meningeal syndrome, often in the context of an infected meningeal breche but rarely amicrobial due to meningeal irritation.

Case presentation: Patient aged 34, admitted to emergency initially for a febrile meningeal syndrome with intracranial hypertension consisting of vomiting, headache, fever between 39-40°C, with meningeal stiffness evident on clinical examination. As part of the emergency management following a lumbar puncture following a normal cerebral CT scan, the patient was immediately put on antibiotics while awaiting the results of additional tests which confirmed the biological infectious syndrome through an increase in CRP and white blood cells with a predominance of neutrophils. After transfer to the infectious diseases department, these tests were supplemented by cerebral MRI angiography, which revealed a sellar and supra-sellar lesional process measuring 22*20*35.8 mm, initially suggesting a cystic craniopharyngioma. Antibiotic therapy was discontinued in view of the normal results of the puncture and a progressive and spontaneous improvement in the paraclinical parameters. A posteriori and after stabilisation of the patient, we reconstructed her medical history revealing a tumour syndrome evolving for 4 months with amenorrhoea for 2 years, supported by the hypopysogram which had revealed panhypopituitarism with corticotropic insufficiency substituted first, thyreotropic insufficiency subsituted 72 hours later and gonadotropic insufficiency.

Discussion: It is commonly accepted that they are either diagnosed based on the presence of abnormal endocrinological secretion or by the compression of a surrounding structure. However, enlargement of a sellar craniopharyngioma can reach the meningeal structures, causing breaches with rinorrhea that can become infected and lead to true meningitis, or more rarely, simple irritation mimicking aseptic meningitis with meningeal syndrome, as in our patient in whom the pituitary adenoma had caused febrile meningeal syndrome.