Brain abscess as the initial presentation of a macroprolactinoma: Case report

Autores de IIS La Fe

• Matilde Rubio Almanza

  Autor

• Rosa Cámara Gómez

  Autor

• Juan Antonio Simal Julian

  Autor

• Agustin Ramos Prol

  Autor

• Carlos Botella Asuncion

  Autor

• Juan Francisco Merino Torres

  Autor

Participantes ajenos a IIS La Fe

• de San Román-Mena LP

Grupos

• Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética clínica

Abstract

Macroprolactinomas may behave invasively and infiltrate the skull base, causing a subsequent thinning that can also lead to a bone defect and a direct route of entry for pathogens. We describe the case of a 34-year-old male admitted to hospital with fever (38 degrees C), headache, stiffness in the neck, diplopia and neurological impairment. Brain magnetic resonance imaging showed two bilateral abscesses in the fronto-parietal areas with intracranial venous sinus thrombosis and a pituitary adenoma that extended from the suprasellar region, eroding the sellar floor into the sphenoid sinus. Laboratory hormone measurements showed increased levels of prolactin and low levels of FSH, LH and testosterone. The patient received antibiotic treatment and surgery was performed. The patient developed central deafness as a neurological deficit. It is advisable to include pituitary adenoma in the differential diagnosis of meningitis even though its onset as intracranial abscess and rectus sinus thrombosis is extremely rare. (C) 2014 Sociedad Espanola de Neurocirugia. Published by Elsevier Espana, S.L.U. All rights reserved.

Keywords

• Brain abscess; Meningitis; Pituitary adenoma; Prolactinoma; Rectus sinus thrombosis; Transsphenoidal surgery