Presumed Pituitary Abscess Without Infectious Source Treated Successfully With Antibiotics Alone

Abstract

A 12-year-old girl developed acute frontal headache and severe visual loss in both eyes. A presumptive diagnosis of pituitary abscess was made on the basis of suggestive magnetic resonance imaging findings. These consisted of a large non-enhancing area within the pituitary gland and thin irregular glandular rim enhancement. There was no evidence of pre-existing intracranial or systemic infection. The patient recovered completely after treatment with intravenous and oral antibiotics without surgical drainage. This case highlights the need for a high index of suspicion for pituitary abscess based on unusual imaging findings even when there is no source of infection.

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

“…Since the first report by Dechambenoit et al (1993) of pituitary abscess treatment using medications, 5 cases of successful recovery by antibiotic therapy alone have been reported in the literature (Kaur et al, 2005;Uchida et al, 2008;Liu et al, 2011). Compared to surgical management, these patients with pituitary abscess treated conservatively with medication alone experienced a full recovery.…”

“…Because cases with treatment of pituitary abscess by medication alone are rarely reported, the required duration of antibiotics has not been well defined. According to previous cases (Dechambenoit et al, 1993;Kaur et al, 2005;Uchida et al, 2008;Liu et al, 2011), >4 weeks of intravenous antibiotic administration is essential in patients with pituitary abscess.…”

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

“…Two reported cases were successfully treated using only antibiotic therapy without surgery. 10,25) One case was successfully treated with hormone replacement therapy. 15) The selection of the appropriate antibiotics was difficult because bacterial cultures were negative in most cases.…”

Pituitary Abscess with Panhypopituitarism Showing T1 Signal Hyperintensity of the Marginal Pituitary Area: A Non-invasive Differential Diagnosis of Pituitary Abscess and Pituitary Apoplexy

“…On the other hand, pituitary abscess presents a heterogeneous low density lesion on CT imaging, and disappearance of T1 hyperintensity of the pituitary posterior lobe (6,16,17) (24). Diabetes insipidus is also observed in about a half of the patients with pituitary abscess (5,(25)(26)(27) (28,29). In the future, successful treatment of pituitary abscess with conservative treatment may increase due to early diagnosis using our diagnostic approach (Table 5) …”