A Patient Presenting Partial Diabetes Insipidus Diagnosed as Pituitary Abscess With Paranasal Sinusitis

Abstract

Pituitary abscess is a rare clinicopathological entity. Although many cases of pituitary abscess have been reported, the origin, etiology, and nature of this condition remain enigmatic. Furthermore, despite remarkable advances in medical technology, preoperative and histopathological diagnosis remains difficult. In this report, we described a 60-year-old patient with pituitary abscess presenting partial diabetes insipidus with paranasal sinusitis and focused on the necessity of surgical exploration of the surrounding pituitary tissue and histopathological confirmation for the precise diagnosis. Prolonged administration of antibiotics is recommended. (The Endocrinologist 2005;15: 10 -13)P ituitary abscess is a rare clinicopathological entity. Although over 200 cases of pituitary abscess have been reported since the early 19th century, the origin, etiology, and nature of this condition remain enigmatic. Furthermore, despite remarkable advances in medical technology, preoperative and histopathological diagnosis remains difficult. In this report, we described a patient of pituitary abscess presenting partial diabetes insipidus with paranasal sinusitis and focused on the necessity of surgical exploration and histopathological confirmation for the precise diagnosis. CASE REPORTA 60-year-old man complained of headache, thirst, polydipsia, and polyuria since August 2002. He was found to have a mass lesion in the pituitary gland and was admitted to our hospital on September 25, 2002. His urinary volume was 5800 to 6600 mL per day. He had a history of bilateral maxillary sinusitis. He was afebrile and free from visual symptoms, except for decreased visual acuity in the right eye due to cataract. General and neurologic examination revealed no abnormality; his body height was 161 cm, body weight 75 kg, blood pressure 140/70 mm Hg. Routine blood tests were normal; white blood cell count 5300, C-reactive protein (CRP) Ͻ0.3. Basal levels of pituitary and its related hormones were within normal values as follows: growth hormone (GH) 0.26 ng/mL (normal range: Ͻ0.42 ng/mL), prolactin (PRL) 4.3 ng/mL (1.5-9.7 ng/mL), luteinizing hormone (LH) 1.1 mIU/mL (0.2-20 mIU/mL) and folliculostimulating hormone (FSH) 3.8 mIU/mL (0.8-22.9 mIU/mL). His plasma adrenocorticotropic hormone (ACTH) and serum cortisol levels were normal, being 11.4 pg/mL (4-40 pg/mL) and 9.4 g/dL (4.0-18.3 g/dL), respectively. Serum TSH was 2.4 U/mL (0.34-3.5 U/mL), and free T4 and free T3 were 0.99 ng/dL (0.83-1.56 ng/dL) and 2.79 pg/mL (2.38-4.23 pg/mL), respectively. Intravenous injection of 500 g of thyrotropin releasing hormone increased serum TSH and PRL from 2.4 U/mL to 13.2 U/mL, from 5.5 ng/mL to 14.0 ng/mL; 100 g of gonadotropin releasing hormone loading increased serum FSH and LH from 3.2 mIU/mL to 10.0 mIU/mL, from 0.9 mIU/mL to 11.0 mIU/mL. One hundred micrograms of GH releasing hormone loading increased serum GH from 0.33 ng/mL to 15.2 ng/mL. One hundred micrograms of corticotropin releasing hormone loading increased plasma ACTH and serum cortisol from ...