Ectopic Prolactinoma Presenting as Bacterial Meningitis: A Diagnostic Conundrum.

Ectopic Prolactinoma Presenting as Bacterial Meningitis: A Diagnostic Conundrum.

World Neurosurg. 2018 Jan 26;:

Authors: Akinduro OO

Abstract
INTRODUCTION: Prolactinomas may rarely present with meningitis and cerebrospinal fluid (CSF) rhinorrhea secondary to erosion of the wall of the sella turcica. It is even more un-common for this abnormal communication to be caused by an ectopic prolactinoma arising from the sphenoid sinus and eroding into the sella. This atypical growth pattern makes diagnosis very difficult, as there may be no displacement of the normal pituitary gland. The authors present the first reported case of a patient with an ectopic prolactinoma presenting primarily with meningitis, and discuss the management strategy as well as surgical and non-surgical treatment options for these patients.
CASE REPORT: A 48-year-old woman presented with confusion, low-pressure headache, and fever. A lumbar puncture revealed Streptococcus pneumonia meningitis and she was placed on penicillin G. After initiation of antibiotics, she noticed salty tasting post-nasal fluid leakage. Imaging was remarkable for bony erosion of the sphenoid sinus wall by a soft tissue mass growing from within the sinus, with no disruption of the normal pituitary gland. We then performed a biopsy with an endoscopic transnasal transsphenoidal (TNTS) approach and repaired the CSF leak with a pedicled nasoseptal flap. The final pathology was prolactinoma and she was placed on cabergoline.
DISCUSSION: Ectopic prolactinomas may rarely present as meningitis secondary to retrograde transmission of bacteria through a bony defect in the sphenoid sinus, and must be included in the differential diagnosis of any sphenoid sinus mass. Management should first address the infection, followed by surgical repair of the bony defect.

PMID: 29378345 [PubMed - as supplied by publisher]

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