Pituitary abscess

Abstract

Pituitary abscess is an uncommon pituitary lesion. Its clinical diagnosis can be difficult to distinguish from other pituitary lesions. This pathology is characterised by vague symptoms of headaches, generalised tiredness and hypopituitarism manifestations. A history of recent meningitis, paranasal sinusitis or head surgery can be a suggestive of the source of infection.A 20-year-old man was admitted to neurosurgery department with complain of headache, fatigue, polyuria, polydipsia, blurred vision and sexual dysfunction. MRI of the head revealed a suprasellar mass that was centrally hyperintense lesion on T2-weighted images with peripheral hypointensity and isointense centrally on T1 images with peripheral hyperintensity images. Treatment of this lesion pituitary abscess was surgical drainage of the pituitary area through a trans-sphenoidal approach and broad spectrum antibiotic therapy with ceftriaxone, metronidazole and vancomycin for 6 weeks. The patient continues to have pituitary insufficiency and treated with oral hydrocortisone.Although pituitary abscess is a rare condition, it should always be kept in mind when evaluating a patient with hypopituitarism. After the diagnosis, the surgery and antibiotics should be commenced rapidly. The outcome is usually good with proper treatment.

Pituitary Abscess: A Challenging Preoperative Diagnosis—A Multicenter Study

“…PAs represented 0.7% of all pituitary gland pathologies. This finding is consistent with previous data from the literature which estimates an incidence of 0.2 to 1.1% of pituitary/sellar lesions [ 3 , 6 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Similar to what is previously described, we also found a gender predilection, with women being more affected than men [ 6 ].…”

“…Clearly, the presence of clear septic state in the context of a sellar mass lowers the threshold for suspecting a primary or secondary PA and for timely treating of it [ 7 ]. Similar to what is previously described, a bacterial or fungal agent could be isolated in only 25% of cases from our series, and the lack of pathologic agent identification represents the main reason to support the start of an empiric antibiotic therapy in the immediate postoperative period in all patients with purulent sellar collections [ 6 , 7 , 14 ]. Although a positive microbiology test in only one out of four patients could appear low, such rate is actually higher than in previous reports [ 3 , 11 , 12 , 13 ].…”