The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

A Case of Pituitary Apoplexy Misdiagnosed as Aseptic Meningitis

무균성 뇌수막염으로 오인된 뇌하수체졸증 1예

  • Yun, Yu-Seon (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Eun-Sook (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Shin, Jung-Ah (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kang, Moo-Il (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Yoon, Kun-Ho (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Cha, Bong-Yun (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Son, Ho-Young (Department of Internal Medicine, The Catholic University of Korea College of Medicine)
  • 윤유선 (가톨릭대학교 의과대학 내과학교실) ;
  • 김은숙 (가톨릭대학교 의과대학 내과학교실) ;
  • 신정아 (가톨릭대학교 의과대학 내과학교실) ;
  • 강무일 (가톨릭대학교 의과대학 내과학교실) ;
  • 윤건호 (가톨릭대학교 의과대학 내과학교실) ;
  • 차봉연 (가톨릭대학교 의과대학 내과학교실) ;
  • 손호영 (가톨릭대학교 의과대학 내과학교실)
  • Published : 2011.01.01
⟨ Previous Next ⟩

Abstract

Pituitary apoplexy is a clinical syndrome caused by an acute ischemic or hemorrhagic vascular accident. Although pituitary apoplexy is an emergency, it is often overlooked because it is rare and presents with various signs and symptoms, including those of neurologic and endocrine disorders. We describe a case of pituitary apoplexy misdiagnosed as aseptic meningitis accompanied by acute-onset headache and nausea, followed by fever. Subsequently, it was revealed as pituitary apoplexy by brain magnetic resonance imaging (MRI) performed when the clinical course worsened and ophthalmoplegia developed. We suggest that pituitary apoplexy be included in the differential diagnosis of patients presenting with headache or signs of meningeal irritation; when there is no clinical improvement, prompt steroid treatment should be started, while considering neurological decompression to prevent neurological sequelae.

본 저자들은 뇌수막염 증상으로 오인되어 치료가 지연, 부신 위기 동반으로 악화된 후 진단된 뇌하수체 선종의 뇌하수체졸증 1예를 경험하여, 무균성 뇌수막염이 호전되지 않을 경우에는 드물지만 치명적인 경과를 보일 수 있는 뇌하수체졸증일 가능성을 상기하고자 이를 보고하는 바이다.

Keywords

References

  1. Reid RL, Quigley ME, Yen SS. Pituitary apoplexy: a review. Arch Neurol 1985;42:712-719. https://doi.org/10.1001/archneur.1985.04060070106028
  2. Bailey P. Pathological report of a case of acromegaly, with special reference to the lesions in the hypophysis cerebri and in the thyroid gland; and a case of hemorrhage into the pituitary. Philadelphia Med J 1898;1:789-792.
  3. Brougham M, Heusner AP, Adams RD. Acute degenerative changes in adenomas of the pituitary body: with special reference to pituitary apoplexy. J Neurosurg 1950;7:421-439. https://doi.org/10.3171/jns.1950.7.5.0421
  4. Onesti ST, Wisniewski T, Post KD. Clinical versus subclinical pituitary apoplexy: presentation, surgical management, and outcome in 21 patients. Neurosurgery 1990;26:980-986. https://doi.org/10.1227/00006123-199006000-00010
  5. Cardoso ER, Peterson EW. Pituitary apoplexy: a review. Neurosurgery 1984;14:363-373. https://doi.org/10.1227/00006123-198403000-00021
  6. Hwang YH, Kim YS, Kim JW, Kim SW, Kim MJ, Choi YK. Pituitary apoplexy: report of 2 cases. Korean J Med 1981; 24:172-176.
  7. Kim JT, Park BJ, Sung JN, Kim YJ, Cho MK. Clinical analysis of pituitary apoplexy. J Korean Neurosurg Soc 2001;30:724-728.
  8. Na MJ, Oh YS, Shin SH. A case of acromegaly associated with pituitary apoplexy. J Korean Soc Endocrinol 1989;4:176-177.
  9. Kim SY, Jung YS. Pituitary apoplexy presenting as meningitis. J Korean Soc Emerg Med 2002;13:94-96.
  10. Ko HS, Kim YH, Ahn HY, et al. Minimally invasive neuroendoscopic surgery for pituitary apoplexy diagnosed during pregnancy. Korean J Obstet Gynecol 2006;49:176-181.
  11. Kim JP, Park BJ, Kim SB, Lim YJ. Pituitary apoplexy due to pituitary adenoma infarction. J Korean Neurosurg Soc 2008;43: 246-249. https://doi.org/10.3340/jkns.2008.43.5.246
  12. Rolih CA, Ober KP. Pituitary apoplexy. Endocrinol Metab Clin North Am 1993;22:291-302.
  13. Wakai S, Yamakawa K, Manaka S, Takakura K. Spontaneous intracranial hemorrhage caused by brain tumor: its incidence and clinical significance. Neurosurgery 1982;10:437-444. https://doi.org/10.1227/00006123-198204000-00004
  14. Wakai S, Fukushima T, Teramoto A, Sano K. Pituitary apoplexy: its incidence and clinical significance. J Neurosurg 1981;55:187-193. https://doi.org/10.3171/jns.1981.55.2.0187
  15. Dubuisson AS, Beckers A, Stevenaert A. Classical pituitary tumour apoplexy: clinical features, management and outcomes in a series of 24 patients. Clin Neurol Neurosurg 2007;109:63-70. https://doi.org/10.1016/j.clineuro.2006.01.006
  16. Ebersold MJ, Laws ER, Scheithauer BW, Randall RV. Pituitary apoplexy treated by transsphenoidal surgery: a clinicopathological and immunocytochemical study. J Neurosurg 1983;58:315-320. https://doi.org/10.3171/jns.1983.58.3.0315
  17. Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA. Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol 1999;51:181-188. https://doi.org/10.1046/j.1365-2265.1999.00754.x
  18. Bills DC, Meyer FB, Laws ER Jr, et al. A retrospective analysis of pituitary apoplexy. Neurosurgery 1993;33:602-608. https://doi.org/10.1227/00006123-199310000-00007