Pituitary Abscess Presenting a Very Rapid Progression

Kotani, Hirokazu; Abiru, Hitoshi; Miyao, Masashi; Kakimoto, Yu; Kawai, Chihiro; Ozeki, Munetaka; Tsuruyama, Tatsuaki; Tamaki, Keiji

doi:10.1097/paf.0b013e3182557dcf

Cited by 12 publications

(9 citation statements)

References 22 publications

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“…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 . However, lethal outcomes have also been reported 1 .…”

Section: Discussionmentioning

confidence: 97%

“…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 .…”

Section: Introductionmentioning

confidence: 99%

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Pituitary Abscess With Unusual Clinical Course

Medić-Stojanoska

Kozić

Bjelan

et al. 2016

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SUMMARY -Th e aim is to present unusual clinical course and magnetic resonance imaging (MRI) features of pituitary abscess. A 59-year-old man presented with fever, polyuria, polydipsia and marked weight loss within the last two months. Basic endocrinology tests revealed the presence of anterior pituitary dysfunction, associated with central diabetes insipidus and increased levels of infl ammatory markers. Th e presence of expansile sellar lesion, showing restricted diff usion signal pattern compatible with acute pituitary pyogenic abscess was found on MRI. Regression of pituitary abscess was obvious during the next few weeks of parenteral antibiotic treatment. Adequate substitution treatment with L thyroxine, hydrocortisone, testosterone and desmopressin was achieved. Seventeen months later, clinical deterioration associated with recurrent pituitary abscess was confi rmed on MRI. Abscess regression was obvious again after conservative treatment. However, control MRI study performed three years after initial scanning revealed the presence of pituitary tumor, most consistent with macroadenoma. Surgical intervention was ordered. Histologic evaluation indicated the presence of fi brotic changes, associated with granulation tissue and rare cellular elements, compatible with chronic infl ammation. To the best of our knowledge, there are no studies in the literature describing such a pattern of chronic evolution of pyogenic pituitary abscess with consequent chronic infl ammatory changes with granulation tissue proliferation, mimicking macroadenoma.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Pituitary Abscess With Unusual Clinical Course

Medić-Stojanoska

Kozić

Bjelan

et al. 2016

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“…The infection can also originate in a pituitary gland with preexisting pathology, with a pituitary adenoma being the most common associated lesion followed by craniopharyngioma and Rathke's cleft cyst (8,10). Regarding the pediatric cases, only 27% (3/11) of the patients had an underlying pituitary gland condition.…”

Section: Discussionmentioning

confidence: 97%

“…Although this disease most commonly has an indolent presentation, a rapid progressive clinical picture with fatal outcome has also been described (8).…”

Section: Discussionmentioning

confidence: 98%

Pituitary abscess in an adolescent girl: a case report and review of the literature

Zegarra-Linares

Moltz²,

Abdel‐Haq³

2014

Journal of Pediatric Endocrinology and Metabolism

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We report the case of a 15-year-old girl who presented with a history of recurrent bitemporal headaches for the last 2 months. In the prior few days, she complained of neck pain, emesis, phonophobia and photophobia, but no fever. Additional symptoms included polydipsia, polyuria and weight gain in the last year. Magnetic resonance imaging (MRI) of the brain demonstrated a cystic sellar and suprasellar mass with peripheral enhancement. Cerebrospinal fluid studies showed pleocytosis. Serum hormone levels were consistent with panhypopituitarism. Transnasal sphenoidotomy was performed, and 2 mL of purulent material was drained, confirming the diagnosis of pituitary abscess. The patient completed 6 weeks of parenteral antibiotics. She improved but continued to require home hormonal replacement therapy. A repeated MRI 3 months later showed abscess resolution. In addition to tumors, pituitary abscess should be considered in children who present with headache and panhypopituitarism, particularly in those who present with signs of meningeal inflammation. Prolonged parenteral antibiotics and surgical drainage are effective.

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“…Kotani et al reported a 60-year-old man with a pituitary abscess associated with a pituitary adenoma who died five days after the onset of clinical symptoms without a definitive diagnosis (65). Postmortem imaging and autopsy findings revealed a sellar mass with cystic change and extension toward the optic chiasm.…”

Section: Pituitary Abscessmentioning

confidence: 99%

The Pituitary Gland: An Infrequent but Multifaceted Contributor to Death

Wang

Gill

2016

Academic Forensic Pathology

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The pituitary gland has an important role in homeostasis and disorders of it can result in endocrine dysfunction and/or produce mass effect on surrounding structures, including the hypothalamus, which can cause significant morbidity and mortality. A definitive clinical diagnosis may be delayed or remain elusive and lead to life-threatening conditions. Specifically, pituitary adenomas, pituitary necrosis, hypophysitis, and abscesses have all been reported in the literature to cause sudden and unexpected death and may only be first encountered at autopsy. Recognition by the forensic pathologist of these rare entities is crucial for appropriate death certification. This review emphasizes the need for a comprehensive, detailed forensic examination, including autopsy and routine histologic sampling of the pituitary gland, in order to ascertain its potential role in sudden unexpected death with no other apparent cause.

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Pituitary Abscess Presenting a Very Rapid Progression

Cited by 12 publications

References 22 publications

Pituitary Abscess With Unusual Clinical Course

Pituitary Abscess With Unusual Clinical Course

Pituitary abscess in an adolescent girl: a case report and review of the literature

The Pituitary Gland: An Infrequent but Multifaceted Contributor to Death

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