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

Pituitary apoplexy most commonly occurs as an acute event with headache, al tered consciousness, visual deficits, ophthalmoplegia and features of hypop ituitarism. A 28-year-old man previously well, presented with a 36-hour his tory of fever, headache and neck stiffness suggestive of meningitis. CSF ex amination was initially interpreted as a sterile meningitis, but there were red cells present and xanthochromia consistent with subarachnoid hemorrhag e, Right sided IIIrd cranial nerve palsy and dense bitemporal hemianopsia d eveloped 3 days later. A computed tomography of the head with contrast show ed a ring enhancing suprasellar mass and an MRI demonstrated a large sellar mass with hemorrhage. Endocrine evaluation, which subsequently became avai lable, showed evidence of panhypopituitarism, Pituitary apoplexy in a nonse cretory adenoma was confirmed at transsphenoidal surgical decompression and by histopathology.