Meningiomas are among the most commonly encountered
tumors of the central nervous system, being more frequent in females. We present the case of a dyslipidemic male patient, previously diagnosed with
coronary artery disease for which he previously underwent
percutaneous coronary intervention with the placement of two bare
metal stents on the left anterior descending artery. He was presented to the emergency department for atypical angina and a seven-day history of
dizziness when switching from clino- to orthostatism, reduced visual acuity,
diplopia and
vomiting. Electrocardiogram (ECG), both at rest and exercise test were suggestive for
myocardial ischemia. Echocardiography revealed myocardial
hypokinesia in the territory of the right coronary artery and of the left descending artery, while coronarography showed insignificant intra-
stent stenosis. Imaging techniques revealed a frontobasal extraneuraxial mass, creating a compressive effect on both middle cerebral arteries and on the optic chiasm as well as thickening of the dura mater adjacent to the mass. Endocrinology blood tests showed hypocortisolemia,
hyperprolactinemia and low levels of free
thyroxine (fT4), suggesting secondary
combined pituitary hormone deficiency. The patient underwent surgery and total resection of the
tumor was performed. Definite diagnosis -
transitional meningioma - was obtained through histological examination and immunohistochemistry. The key feature of this case was the extra-cardiac cause of angina accompanied by ECG abnormalities in a patient with stable
coronary heart disease, in whom the clinical presentation was secondary to blood pressure variations in the context of pituitary and adrenal deficiency.