Diagnosis and management of pituitary abscess: a case series and review of the literature

Abstract

AIm: Pituitary abscess is a disorder characterized with central nervous system (CNS) infection, mass effect, and endocrine dysfunction. These abscesses generally occur due to hematogenous spread in conditions such as paranasal sinusitis, sepsis, and where the blood brain barrier breaks down. This paper aims to discuss four cases of preoperatively diagnosed pituitary abscess in the light of the literature. Results: All the patients showed fever, systemic signs of toxemia and endocrine dysfunction at the time of diagnosis. In these cases, a preoperative diagnosis of the disease was made thanks to characteristic MRI findings. The four cases were operated by the transnasal transsphenoidal approach and histopathological and microbiological studies were performed for surgical specimens.ConClusIon: Pituitary abscesses are rare disorders responsible for a high mortality risk. Mortality and morbidity can be reduced by early surgical drainage and appropriate antibiotic treatments. Additionally, these cases should be closely followed-up in terms of pituitary insufficiency, surgical complications and infection.

Steroid-resistant Tolosa-Hunt syndrome with a de novo intracavernous aneurysm: A case report

“…[251329] Pituitary abscess is very rare, with only 0.2–1% among all pituitary diseases. There are two types of pituitary abscesses.…”

Pituitary Abscess With Unusual Clinical Course

“…[8][9][10] . Th e most common clinical presentations are diabetes insipidus and the triad of headache, visual disorders and hypopituitarism 2,8,11 . Complete recovery rate was around 60% in patients where adequate treatment was administered, while 30% of patients showed incomplete recovery with visual or endocrine impairment 2,10 .…”

“…Clinical presentation is rather nonspecifi c, ranging from acute to chronic or even indolent course 1 . Hematogenous spread, or direct extension from an infected neighboring tissue, in conditions such as paranasal sinusitis, sepsis, meningitis, cavernous sinus thrombophlebitis, pituitary surgery and tooth infection, are the main risk factors for this disease 2,3 . Recurrent meningitis as a presenting manifestation of pituitary abscess is rare but has been reported in the literature 4 .…”

“…Pituitary abscess accounts for less than 1% of pituitary lesions 5,6 . Numerous manuscripts on this topic are available, of which most are case reports 2 . Th e purpose of this report is to present the unusual clinical course and magnetic resonance (MRI) features of pituitary abscess.…”

Pituitary abscess in an HIV-1-infected patient

“…The pituitary lesion had gadolinium ring enhancement, high-intensity signals on diffusion-weighted imaging (DWI), and low-intensity signals on apparent diffusion coefficient (ADC) imaging, characteristic findings for an abscess of the pituitary gland (Figure 2(c)–(f)). 4,12 Cefepime was continued for 1 week before the decision to switch to ceftriaxone was taken (due to better CNS penetration). Then, ceftriaxone (2 g/day) was administered for a total of 3 weeks, with improvement of the lesions on follow-up MRI scans (Figure 3(a) and (b)).…”