Chemical meningitis and syndrome of inappropriate antidiuretic hormone release (SIADH): a rare presentation of pituitary adenoma apoplexy
  • Nicolas Sandakly
    Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon; Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Achrafieh, Lebanon
  • Georgio El Koubayati
    Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon; Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Achrafieh, Lebanon
  • Abir Ayoub
    Faculty of Medical Sciences, Lebanese University, Hadath Campus, Hadath, Lebanon
  • Claude Ghorra
    Department of Pathology, Lebanese Hospital Geitaoui University Medical Center, Achrafieh, Lebanon
  • Fady G. Haddad
    Department of Internal Medicine, Lebanese Hospital Geitaoui University Medical Center, Achrafieh, Lebanon

Keywords

Pituitary adenoma, pituitary apoplexy, SIADH, chemical meningitis

Abstract

Pituitary apoplexy is an uncommon condition typically resulting from a sudden haemorrhage within a pituitary adenoma. This bleed can present clinically with a wide array of signs and symptoms. This report documents the case of a 62-year-old male who presented to the Lebanese Hospital Geitaoui University Medical Center with signs and symptoms of meningeal irritation. He was initially thought to have meningitis, and was started on antibiotics; he was then found to have pituitary adenoma apoplexy that was complicated by syndrome of inappropriate antidiuretic hormone release (SIADH). The patient was successfully treated with antibiotics, and fluid restriction and hypertonic saline after ruling out other more common causes for his hyponatraemia, before undergoing a transsphenoidal resection of the pituitary adenoma. A three-month follow-up evaluation of the patient demonstrated the absence of hormonal imbalances and the absence of residual tumours on imaging.

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References

  • Ishii M. Endocrine emergencies with neurologic manifestations. Continuum (Minneap Minn) 2017;23:778–801.
  • Freda PU, Post KD. Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am 1999;28:81–117.
  • Saeger W, Lüdecke DK, Buchfelder M, Fahlbusch R, Quabbe H-J, Petersenn S. Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur J Endocrinol 2007;156:203–216.
  • Capatina C, Inder W, Karavitaki N, Wass JAH. Management of endocrine disease: pituitary tumour apoplexy. Eur J Endocrinol 2015;172:R179–190.
  • Dodick DW, Wijdicks EF. Pituitary apoplexy presenting as a thunderclap headache. Neurology 1998;50:1510–1511.
  • Mattke AF, Vender JR, Anstadt MR. Pituitary apoplexy presenting as Addisonian crisis after coronary artery bypass grafting. Tex Heart Inst J 2002;29:193–199.
  • Biousse V, Newman NJ, Oyesiku NM. Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry 2001;71:542–545.
  • Huang W-Y, Chien Y-Y, Wu C-L, Weng W-C, Peng T-I, Chen H-C. Pituitary adenoma apoplexy with initial presentation mimicking bacterial meningoencephalitis: a case report. Am J Emerg Med 2009;27:517.e1–4.
  • Bjerre P, Lindholm J. Pituitary apoplexy with sterile meningitis. Acta Neurol Scand 1986;74:304–307.
  • Fernandez A, Karavitaki N, Wass JA. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf.) 2010;72:377–382.
  • Ogawa Y, Niizuma K, Mugikura S, Tominaga T. Ischemic pituitary adenoma apoplexy – clinical appearance and prognosis after surgical intervention. Clin Neurol Neurosurg 2016;148:142–146.
  • Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA. Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol (Oxf.) 1999;51:181–188.
  • Wakai S, Fukushima T, Teramoto A, Sano K. Pituitary apoplexy: its incidence and clinical significance. J Neurosurg 1981;55:187–193.
  • Barkhoudarian G, Kelly DF. Pituitary apoplexy. Neurosurg Clin N Am 2019;30:457–463.
  • Müller-Jensen A, Lüdecke D. Clinical aspects of spontaneous necrosis of pituitary tumors (pituitary apoplexy). J Neurol 1981;224:267–271.
  • Bills DC, Meyer FB, Laws ER Jr, Davis DH, Ebersold MJ, Scheithauer BW, et al. A retrospective analysis of pituitary apoplexy. Neurosurgery 1993;33:602–609.
  • Semple PL, Jane JA, Lopes MBS, Laws ER. Pituitary apoplexy: correlation between magnetic resonance imaging and histopathological results. J Neurosurg 2008;108:909–915.
  • Randall BR, Couldwell WT. Apoplexy in pituitary microadenomas. Acta Neurochir (Wien) 2010;152:1737–1740.
  • Fernández-Balsells MM, Murad MH, Barwise A, Gallegos-Orozco JF, Paul A, Lane MA, et al. Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J Clin Endocrinol Metab 2011;96:905–912.
  • Reid RL, Quigley ME, Yen SS. Pituitary apoplexy. A review. Arch Neurol 1985;42:712–719.

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    Published: 2023-11-17
    Issue: 2023: Vol 10 No 12 (view)

    How to cite:
    1.
    Sandakly N, El Koubayati G, Ayoub A, Ghorra C, Haddad FG. Chemical meningitis and syndrome of inappropriate antidiuretic hormone release (SIADH): a rare presentation of pituitary adenoma apoplexy. EJCRIM 2023;10 doi:10.12890/2023_004155.