Pituitary abscess: a case report and review of the literature

Abstract

SummaryPituitary abscess is a rare life-threating entity that is usually misdiagnosed as a pituitary tumor with a definite diagnosis only made postoperatively. Over the last several decades, advances in healthcare have led to a significant decrease in morbidity and mortality due to pituitary abscess. We report a case of a 34-year-old woman who was admitted to our department for investigation of a pituitary mass and with symptoms of pituitary dysfunction, headaches and impaired vision. During her admission, she developed meningitis-like symptoms and was treated with antibiotics. She eventually underwent transsphenoidal surgery for excision of the pituitary mass. A significant amount of pus was evident intraoperatively; however, no pathogen was isolated. Six months later, the patient was well and had full recovery of the anterior pituitary function. Her menses returned, and she was only on treatment with desmopressin for diabetes insipidus that developed postoperatively.Learning pointsPituitary abscess is a rare disease and the reported clinical features vary mimicking other pituitary lesions.The diagnosis of pituitary abscess is often very difficult to make and rarely included in the differential.The histological findings of acute inflammatory infiltration confirm the diagnosis of pituitary abscess.Medical and surgical treatment is usually recommended upon diagnosis of a pituitary abscess.

Pituitary abscess: report of two cases and review of the literature

“…It is indicated that empirical treatment should be given to the patients who are waiting for microbiology and histological confirmation 9,12. Hormone replacement therapy is needed based on pituitary hormone deficiency 12,18. Our patients received antibiotic and hormone replacement therapy after transsphenoidal excision.…”

Spontaneous rupture of a secondary pituitary abscess causing acute meningoencephalitis: Case report and literature review

“…Since its first descriptions (Heslop, 1848),[ 3 ] PA has represented a diagnostic challenge, due to its unspecific clinical features,[ 13 17 ] radiologic signs,[ 6 ] and to its rarity. [ 1 10 ] PAs have largely been reported as single cases, but recently some series have been published. [ 12 17 19 ]…”

“…Prompt therapy can reduce mortality to less than 10%. [ 1 10 13 16 17 ] The transnasal approach is the most used, because it is thought to expose to less risk of CSF contamination. [ 1 3 5 11 15 ] Craniotomy is not contraindicated and is preferred in cases with relevant suprasellar extension and in redo surgeries, though higher recurrence rates are associated with craniotomies.…”

“…[ 1 ] There is a higher risk of permanent pituitary deficits for those patient with a long history of symptoms. [ 10 ] Recurrence is rare, but possible in 10% of cases. [ 1 6 12 ]…”

“…In many cases no microorganism can be isolated from cultures. [ 1 9 10 14 ] Mortality in untreated PA is reported at 30% and need for long-term hormonal replacements at approximately 70%. [ 1 8 15 17 ]…”