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Case Reports
. 2013 Oct;17(Suppl 1):S117-21.
doi: 10.4103/2230-8210.119524.

Suppurative meningitis: A life-threatening complication in male macroprolactinomas

Farida Chentli  1 , Lina Akkache, Katia Daffeur, Meriem Haddad, Said Azzoug
Affiliations
Case Reports

Suppurative meningitis: A life-threatening complication in male macroprolactinomas

Farida Chentli et al. Indian J Endocrinol Metab. 2013 Oct.

Abstract

Background: Suppurative meningitis (SM) or bacterial meningitis is a life-threatening condition, which is exceptionally due to pituitary tumors (PT). Our aim was to analyze its frequency among male macroprolactinomas (MPRL) deemed to be aggressive, to report the cases we observed in our practice and describe the circumstances under which SM appeared.

Materials and methods: We retrospectively analyzed 82 male MPRL in order to look for a history of well proved SM and the circumstances under which SM appeared. We also took into account the possibility of SM relapsing.

Results: Four out of 82 male MPRL had SM = 4.87%. Three consulted for SM symptoms. SM was confirmed in Infectious Diseases department, but only one had rhinorrhea. Hormonal assessment and cerebral magnetic resonance imaging pleaded for aggressive prolactinomas. After antibiotics, SM was sterilized. Then, MPRL were treated with bromocriptine, which normalized prolactin and reduced PT. SM never relapsed. The 4(th) case was hospitalized for a large multidirectional prolactinoma invading and/or arising from the skull base. He was operated on 3 times and then he was given Bromocriptine. After 3 months, he had rhinorrhea and then SM which was successfully treated by antibiotics. SM never relapsed after tumor reduction.

Conclusion: SM was demonstrated in 4.87%. SM has revealed MPRL in 3 cases and appeared after bromocriptine intake in the 4(th) one. Endocrinologists should be aware of this severe condition, which can be avoided by repairing as soon as possible the bony defect secondary to aggressive tumors, unless it is clogged by fibrosis: What probably happened in our cases.

Keywords: Aggressive tumors; male prolactinomas; suppurative meningitis.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Invasive and aggressive pituitary tumor destroying the sella floor, responsible for suppurative meningitis (SM) in a 22-year-old man. (a) Before bromocriptine; (b) After treatment, bromocriptine intake and SM disappearance
Figure 2
Figure 2
Large invasive tumor destroying the sella floor, responsible for suppurative meningitis in a 49-year-old man. (a) Before medical treatment; (b) Liquification of the tumor after bromocriptine
Figure 3
Figure 3
The pituitary tumor filling the sphenoid sinus before bromocriptine (a) and after bromocriptine (b)
Figure 4
Figure 4
MRI showing a large tumor invading cavernous sinuses, the brain and sphenoid sinus (a). After dopamine agonists (b) the tumor size was reduced
See this image and copyright information in PMC

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