PMID- 34993034
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220108
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 13
IP  - 12
DP  - 2021 Dec
TI  - Multiple Endocrine Neoplasia Type 1 (MEN1) Presenting as an Invasive 
      Macroprolactinoma Complicated by Acute Bacterial Meningitis.
PG  - e20086
LID - 10.7759/cureus.20086 [doi]
LID - e20086
AB  - Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant disorder 
      characterized by tumors of parathyroid, anterior pituitary, and pancreatic islet 
      cells. Pituitary adenomas in MEN1 can be aggressive and invade surrounding 
      structures including the skull base. However, acute bacterial meningitis in 
      patients with newly diagnosed macroprolactinomas is an exceptional finding. We 
      present the case of a young man with suppurative meningitis complicating an 
      invasive macroprolactinoma as the initial manifestation of MEN1. A 33-year-old 
      male was admitted to the hospital with fever, headache, and nuchal rigidity and 
      subsequently diagnosed with Haemophilus influenzae bacterial meningitis. Computed 
      tomography (CT) and subsequent magnetic resonance imaging (MRI) of the sella 
      turcica revealed a 5 x 3.5 cm pituitary mass invading both cavernous sinuses and 
      the left sphenoid sinus. Laboratory evaluation was notable for significantly 
      elevated serum prolactin level (2,484 ng/mL, 2.6-13.2) and evidence of 
      hypopituitarism. Primary hyperparathyroidism was indicated by hypercalcemia (13.5 
      mg/dL, 8.5-10.5), low serum phosphorus (2.0 mg/dL, 2.5-4.9), and elevated intact 
      parathyroid hormone (PTH) level (290 pg/mL, 15-60). No visual field deficits were 
      identified. The patient was managed with hydrocortisone, levothyroxine, and 
      cabergoline. However, cerebral spinal fluid (CSF) rhinorrhea compelled subtotal 
      transsphenoidal resection of the tumor and repair of the CSF leak. 
      Three-and-a-half gland parathyroid resection was performed after recovery from 
      pituitary surgery and successfully treated hypercalcemia. Abdominal MRI revealed 
      a 1.2 cm cystic mass in the neck of the pancreas, and pancreatic polypeptide was 
      approximately fourfold elevated. A clinical diagnosis of MEN1 was made based on 
      the occurrence of macroprolactinoma, multiple parathyroid adenomas, and 
      pancreatic findings. This case appears to be the first in which bacterial 
      meningitis was the initial presentation of an invasive macroprolactinoma in a 
      patient with MEN1.
CI  - Copyright (c) 2021, Bandaru et al.
FAU - Bandaru, Sindhura
AU  - Bandaru S
AD  - Endocrinology, Terrebonne General Medical Center, Springfield, USA.
FAU - Jaju, Amruta
AU  - Jaju A
AD  - Endocrinology, Southern Illinois University School of Medicine, Springfield, USA.
FAU - Manthri, Sukesh
AU  - Manthri S
AD  - Oncology, Mary Bird Perkins Cancer Center, Houma, USA.
FAU - Mamillapalli, Chaitanya
AU  - Mamillapalli C
AD  - Endocrinology, Springfield Clinic/Southern Illinois University School of 
      Medicine, Springfield, USA.
FAU - Jakoby, Michael G 4th
AU  - Jakoby MG 4th
AD  - Endocrinology, Southern Illinois University School of Medicine, Springfield, USA.
LA  - eng
PT  - Case Reports
DEP - 20211201
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC8719911
OTO - NOTNLM
OT  - bacterial meningitis
OT  - csf rhinorrhea
OT  - macroprolactinoma
OT  - male predisposition
OT  - multiple endocrine neoplasia type 1 (men1)
COIS- The authors have declared that no competing interests exist.
EDAT- 2022/01/08 06:00
MHDA- 2022/01/08 06:01
PMCR- 2021/12/01
CRDT- 2022/01/07 06:27
PHST- 2021/11/30 00:00 [accepted]
PHST- 2022/01/07 06:27 [entrez]
PHST- 2022/01/08 06:00 [pubmed]
PHST- 2022/01/08 06:01 [medline]
PHST- 2021/12/01 00:00 [pmc-release]
AID - 10.7759/cureus.20086 [doi]
PST - epublish
SO  - Cureus. 2021 Dec 1;13(12):e20086. doi: 10.7759/cureus.20086. eCollection 2021 
      Dec.