Pituitary abscess: our experience with a case and a review of the literature

Abstract

Pituitary abscess is a rare disease. Due to its potentially high mortality and morbidity rate, it should be considered in the differential diagnosis of sellar masses. Despite recent advances in radiological investigations, making a definitive diagnosis preoperatively remains challenging. This 45-year-old Indian gentleman presented with severe throbbing headache for six months. Magnetic resonance imaging of the brain revealed a sellar mass with peripheral enhancement that was misdiagnosed as a pituitary macroadenoma. A trans-sphenoidal excision was done, which surprisingly yielded only pus that was drained accordingly from the lesion. Fungal and bacterial cultures were negative. However this patient subsequently lost complete function of the pituitary gland, resulting in central diabetes insipidus and required permanent hormonal replacement therapy in the deficient endocrine axes. A Medline search was conducted and a review of 24 cases reported in the last 5 years discussed.

Successful treatment of pituitary abscess with intravenous antibiotics: a case report and literature review

“…The remaining patients continued to require hormone replacement therapy, and 6 of the 21 patients with preoperative diabetes insipidus required postoperative desmopressin acetate. Insufficient endocrinological recovery has also been reported in other case series (Vates et al, 2001;Ciappetta et al, 2008;Dalan and Leow, 2008). Surgery can also result in secondary destruction of the pituitary gland.…”

“…Half of the patients do not have underlying risk factors for pituitary Treatment of pituitary abscess with intravenous antibiotics infection, such as bloodstream infections, direct extension from a focus around the intrasellar region, or disease following an intrasellar tumor or post-pituitary operation (Tekkök et al, 2001). Furthermore, systemic signs of inflammation, such as fever and leukocytosis, are reported in only 24-33% of patients with a pituitary abscess (Vates et al, 2001;Dalan and Leow, 2008).…”

Endoscopic Trans-Sphenoidal Drainage of Pituitary Abscess: A Rare Case Report

“…Hence, it is important to do a Gram-staining and culture of the pus and to treat with appropriate antibiotics in the postoperative period to reduce the risk of recurrence. Hormone replacement therapy is administrated based on hormone deficits of the pituitary gland [14,15]. We have treated out patient with empirical antibiotics.…”

Pituitary Abscess Manifesting as Meningitis and Photophobia Associated With Rathke's Cleft Cyst in a Child -Case Report-

“…Other risk factors are underlying immunocompromised condition, previous pituitary surgery, and irradiation of the pituitary gland. 5) Pituitary abscess occurred in association with preexisting growing lesions in 37% of all reported cases, including pituitary adenoma in 11.4%, Rathke's cleft cyst in 5.4%, and craniopharyngioma in 5%. 4) Only 19 cases of pituitary abscess associated with Rathke's cleft cyst have been reported.…”