SHM Converge Scientific Abstract ePoster Gallery-It All Began With a Migraine: A Tale of Sinusitis, Pituitary Perils, and Cavernous Conundrums

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A 73-year-old woman with hypertension and migraines initially presented to the ED with nausea, headache, and photophobia. She was treated symptomatically, then returned with worsening symptoms. Lumbar puncture was unrevealing, and pyuria led to treatment for presumed UTI with ceftriaxone. Although her symptoms improved briefly, she returned a week later with fever and double vision.<br /><br />Because fever plus ocular findings suggested a more serious process, imaging was pursued. MRI of the orbits showed skull base osteomyelitis and a 12 × 7 × 9 mm hypoenhancing pituitary mass concerning for a pituitary abscess. CT venography demonstrated bilateral cavernous sinus thrombosis (CST). She was treated with six weeks of ceftriaxone and vancomycin, along with apixaban. Endocrine testing revealed central hypoadrenalism and hypothyroidism, so hydrocortisone and levothyroxine were started. Follow-up imaging showed resolution of both the osteomyelitis and pituitary abscess.<br /><br />The report emphasizes that pituitary abscesses may be primary or secondary, and that endocrine abnormalities often suggest panhypopituitarism. Infectious symptoms may be absent or subtle. CST is a dangerous complication of infection and thrombosis in the cavernous sinus, often presenting with headache, periorbital swelling, and cranial nerve deficits. Because symptoms can be nonspecific, fever and cranial nerve or ophthalmic findings should prompt urgent imaging and treatment to reduce morbidity and mortality.

Asset Subtitle

Cheryl Kalapura

Meta Tag

Author List Cheryl Kalapura, Noppon P. Setji

Category Clinical Vignettes

Concept Skull Base Infection

Concept Pituitary Abscess

Concept Cavernous Sinus Thrombosis

Concept Hypopituitarism

Concept Secondary Pituitary Abscess

Distinguished Non-Finalist

Presenter Organization Duke University School of Medicine

Presenting Author Cheryl Kalapura

Track Adult

Keywords

pituitary abscess

cavernous sinus thrombosis

skull base osteomyelitis

headache

fever

double vision

central hypoadrenalism

hypothyroidism

MRI orbits

ceftriaxone vancomycin

Skull Base Infection

Pituitary Abscess

Cavernous Sinus Thrombosis

Hypopituitarism

Secondary Pituitary Abscess