Case report: Pituitary apoplexy presenting as sterile meningitis and subarachnoid hemorrhage

Pituitary apoplexy most commonly occurs as an acute event with headache, altered consciousness, visual deficits, ophthalmoplegia and features of hypopituitarism. A 28-year-old man previously well, presented with a 36-hour history of fever, headache and neck stiffness suggestive of meningitis. CSF examination was initially interpreted as a sterile meningitis, but there were red cells present and xanthochromia consistent with subarachnoid hemorrhage, Right sided IIIrd cranial nerve palsy and dense bitemporal hemianopsia developed 3 days later. A computed tomography of the head with contrast showed a ring enhancing suprasellar mass and an MRI demonstrated a large sellar mass with hemorrhage. Endocrine evaluation, which subsequently became available, showed evidence of panhypopituitarism, Pituitary apoplexy in a nonsecretory adenoma was confirmed at transsphenoidal surgical decompression and by histopathology.