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

Abstract

Pituitary abscess is a rare but critical disorder caused by an infectious process where purulent material accumulates inside the sella turcica. Since symptoms, signs and radiographic characteristics of pituitary abscess are similar to several other pituitary lesions, correct diagnosis before surgery is challenging. In this article, two cases of pituitary abscess treated in our department are reported, followed by a literature review. In these two cases, both patients presented with intermittent fever. Magnetic resonance imaging revealed a suprasellar lesion with rim enhancement after contrast injection. After transsphenoidal surgery, the diagnosis of pituitary abscess was confirmed. The patients were then given antibiotic treatment and recovered fully in less than 2 months. Findings of this article support timely diagnosis and proper treatment including transsphenoidal surgery and antibiotic therapy for pituitary abscess, leading to lower mortality rates and higher probability of pituitary hormone function recovery.

Erosion of the sella turcica and pituitary expansion secondary to polymicrobial brain abscesses: a case report

“…While it is possible that pituitary enlargement can be explained by an inflammatory reaction secondary to pituitary infarction, new bony erosion of the sella in the setting of pituitary expansion argues more for an infective aetiology. Endocrine abnormalities, such as central diabetes insipidus and hyperprolactinemia, have been associated with PA patients [21,22]. However, SIADH is a rare complication due to pituitary inflammation in the setting of multifocal polymicrobial BA.…”

“…While rare, pituitary abscesses (PA) have been described and account for less than 1 % of all pituitary lesions. They have been described secondary to Staphylococcus spp, Streptococcus spp, Neisseria spp, and Escherichia coli infections [21, 22]. About 70 % of the pituitary abscesses arise de novo , but may complicate a pre-existing lesion, such as a pituitary adenoma [22].…”

“…They have been described secondary to Staphylococcus spp, Streptococcus spp, Neisseria spp, and Escherichia coli infections [21, 22]. About 70 % of the pituitary abscesses arise de novo , but may complicate a pre-existing lesion, such as a pituitary adenoma [22]. While it is possible that pituitary enlargement can be explained by an inflammatory reaction secondary to pituitary infarction, new bony erosion of the sella in the setting of pituitary expansion argues more for an infective aetiology.…”

Secondary pituitary abscess following transsphenoidal surgery with recurrent meningitis

“…[14] Most PAs are idiopathic and occur in a previously healthy gland, whereas PAs in approximately one-third of patients are associated with preexisting pathologic lesions, such as craniopharyngioma, Rathke cleft cyst, or pituitary adenoma. [15,16] Reports of secondary PA following TS are even rarer because of challenges in accurate preoperative diagnosis. [17] However, with TS as the mainstay of surgical treatment for pituitary tumors, secondary PA is a rare but severe complication.…”

“…However, once secondary PA develops, surgical drainage via a transsphenoidal approach is the optimal treatment to prevent further spread of the infection and vision compromise. [15] Any foreign body or devascularized tissue should be removed during surgical exploration. [11] In our patient, once the imaging findings of secondary PA appeared, the 2nd TS was performed quickly to achieve satisfactory prognosis including full recovery of her visual field and improved pituitary function.…”