Pituitary abscess: two case reports

Abstract

BackgroundPituitary abscess is a rare condition with nonspecific symptoms that can be delayed. Proper diagnosis needs to occur preoperatively so that the management can be set up accordingly. Accurate diagnosis is challenging because many differential diagnoses can exhibit the same magnetic resonance imaging features.Case presentationWe report two cases of pituitary abscess. The first patient was a 66-year-old Arab woman who underwent a surgical procedure for a pituitary macroadenoma and presented 3 months later with chronic headaches and panhypopituitarism. A pituitary abscess was found on the follow-up magnetic resonance imaging. The second patient was a 64-year-old Arab man with no medical history who presented with a chiasmal syndrome with headaches and panhypopituitarism. Brain magnetic resonance imaging showed a heterogeneous pituitary mass that turned out to be a pituitary abscess intraoperatively. These two patients were treated with hormone substitution, endoscopic transsphenoidal drainage, and antibiotherapy, with excellent outcomes.ConclusionsPituitary abscess is a rare and serious condition. Preoperative diagnosis can be challenging because of the many existing differential diagnoses upon imaging. Magnetic resonance imaging is the mainstay technique of imaging due to its multimodal nature. These cases demonstrate the variable patterns of a pituitary abscess seen on magnetic resonance imaging and the potential difficulties in achieving an accurate diagnosis preoperatively due to many other conditions potentially exhibiting the same magnetic resonance imaging features.

Unusual Sella Mass: Pituitary Abscess (PA)

“…Pituitary hormone deficiencies persist in the majority of patients following treatment Up to 70% of patients with PA can have central Diabetes insipidus. In contrast, fever with signs of meningeal irritation is reported in 25% of cases [5]. MRI is the imaging of choice for the pituitary lesions.…”

“…The clinical presentation of PA is nonspecific, such as headaches, pituitary hypofunction, and visual disturbances, whereas the infection can be discreet and inconstant [5,6]. Symptoms can be acute, subacute, or chronic, explaining the late diagnosis; in some cases.…”

Pituitary Abscess as Manifestation of IgG4-Related Hypophysitis: A Case Report

“…IgG4-related hypophysitis represents 30% of all primary forms [12], is characterized by a mononuclear infiltration enriched in lymphocytes and plasma cells, with more than 10 IgG4-positive cells per HPF and typical morphological features (storiform fibrosis or obliterative phlebitis) [7,8,13]. Non-infectious pituitary abscess or sterile abscess are a controverse entity, indeed in some Authors' opinion, sterile abscess results from liquefaction of necrosis of an infarcted pituitary gland or the contents of an atypical pituitary cyst [14,15]. However-as in the current case-patients typically present with no fever, no leukocytosis, and culture results are negative.…”

Abnormal magnetic resonance imaging of the sellar region and its surroundings in patients with pituitary abscess

“…Moreover, pituitary abscess is slightly more common in females. Most of the published literature focusing on pituitary abscess were case reports [1,3], with the most significant number of cases (66 cases) in [8]. It has been shown that preoperative diagnosis of a pituitary abscess is challenging [9,10].…”

“…More than 300 patients have been reported so far were misdiagnosed before surgery [2]. Before surgery, a preliminary diagnosis is essential for formulating surgical plans and perioperative management [3]. Imaging is the primary method to confirm the diagnosis of pituitary abscess before surgery.…”