Primary Sellar Abscesses: A Systematic Review and 2 Rare Observations

Shkarubo, A N; Chernov, I V; Pronin, Igor; Agrba, S B; Andreev, D N; Sinelnikov, Mikhail Y.

doi:10.1016/j.wneu.2021.05.137

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…PAs represented 0.7% of all pituitary gland pathologies. This finding is consistent with previous data from the literature which estimates an incidence of 0.2 to 1.1% of pituitary/sellar lesions [ 3 , 6 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Similar to what is previously described, we also found a gender predilection, with women being more affected than men [ 6 ].…”

Section: Discussionsupporting

confidence: 93%

Pituitary Abscess: A Challenging Preoperative Diagnosis—A Multicenter Study

et al. 2023

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Background and Objectives: Pituitary abscess (PA) is a rare occurrence, representing less than 1% of pituitary lesions, and is defined by the presence of an infected purulent collection within the sella turcica. Pas can be classified as either primary, when the underlying pituitary is normal prior to infection, or secondary, when there is associated a pre-existing sellar pathology (i.e., pituitary adenoma, Rathke’s cleft cysts, or craniopharyngioma), with or without a recent history of surgery. Preoperative diagnosis, owing to both non-specific symptoms and imaging features, remains challenging. Treatment options include endonasal trans-sphenoidal pus evacuation, as well as culture and tailored antibiotic therapy. Methods: A retrospective multicenter study, conducted on a prospectively built database over a 20-year period, identified a large series of 84 patients harboring primary sellar abscess. The study aimed to identify crucial clinical and imaging features in order to accelerate appropriate management. Results: The most common clinical presentation was a symptom triad consisting of various degrees of asthenia (75%), visual impairment (71%), and headache (50%). Diagnosis was achieved in 95% of cases peri- or postoperatively. Functional recovery was good for visual disturbances and headache. Pituitary function recovery remained very poor (23%), whereas the preoperative diagnosis represented a protective factor. Conclusions: In light of the high prevalence of pituitary dysfunction following the management of PAs, early diagnosis and treatment might represent a crucial issue. Currently, there are no standard investigations to establish a conclusive preoperative diagnosis; however, new, emerging imaging methods, in particular nuclear imaging modalities, represent a very promising tool, whose potential warrants further investigations.

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Section: Discussionsupporting

confidence: 93%

Pituitary Abscess: A Challenging Preoperative Diagnosis—A Multicenter Study

et al. 2023

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“…Secondary pituitary abscess usually occurs after surgical treatment, irradiation, or because of the direct presence of another pathology within the sellar area. 10 In our cases, since both patients lacked prior surgical treatment, irradiation, and other pathology in the sellar area, it is most likely that they were both primary pituitary abscesses. Furthermore, gram-positive bacteria are the most common causative agents for primary, culture-positive pituitary abscess, and cultures obtained from both of our patients grew gram-positive bacteria.…”

Section: Discussionmentioning

confidence: 72%

“… 7 In most cases, pituitary abscesses display hypointensity or isointensity on T1-weighted imaging, hyperintensity or isointensity on T2-weighted imaging, and rim enhancement after gadolinium injection. 2 3 8 9 10 However, since these MRI findings are not unique to pituitary abscess, it is difficult to rely on them alone to distinguish an abscess from a pituitary adenoma or from other cystic lesions of the sella, such as Rathke cleft cysts, cystic craniopharyngiomas, and cystic adenomas. 2 Therefore, the MRI findings are most diagnostically valuable in the context of the clinical presentation.…”

Section: Discussionmentioning

confidence: 99%

“…Although pituitary abscess is often initially misdiagnosed as pituitary adenoma, as was the case in both patients presented here, surgical resection is the primary treatment option for both entities, with transsphenoidal surgery (TSS) being the recommended approach. 9 10 12 TSS is safe, effective, and minimally invasive, and it also is associated with minimal to no mortality, morbidity, or complications. 3 8 Individual case series 3 9 report the resolution of headaches and visual disturbances in most of their patients after abscess removal.…”

Section: Discussionmentioning

confidence: 99%

“…In the first case, hematogenous infection may have occurred after an upper respiratory tract infection, and in the second case, a prior dental procedure may have facilitated hematogenous spread of an existing sinus infection. Secondary pituitary abscess usually occurs after surgical treatment, irradiation, or because of the direct presence of another pathology within the sellar area 11 . In our cases, since both patients lacked prior surgical treatment, irradiation, and other pathology in the sellar area, it is most likely that they were both primary pituitary abscess.…”

Section: Etiologymentioning

confidence: 99%

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Primary Pituitary Abscess: Two Case Reports

Ghosh,

Pecorari,

Funari

et al. 2024

J Neurol Surg Rep

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Introduction Pituitary abscess is a rare disorder that represents a small fraction of all pituitary lesions. In this report, we present two additional cases with unique features to promote awareness and prompt surgical intervention. Case Presentations A 42-year-old male presented with headache, photophobia, subjective fever, dizziness, imbalance, nausea, and vomiting. A pituitary hormone panel confirmed hypothyroidism and suggested central hypogonadism and secondary adrenal insufficiency (AI). MRI showed a large sellar mass measuring 2.5 cm x 1.8 cm x 1.6 cm (CC x XT x AP). A 76-year-old woman presented with several months of headaches and unsteady gait in the setting of a known previously asymptomatic sellar lesion, measuring 1.8 cm x 1.2 cm x 1.5 cm (XT x CC x AP). Repeat MRI demonstrated possible hemorrhage within the lesion. In both cases, a preliminary diagnosis of pituitary macroadenoma was made, but transsphenoidal surgery revealed an encapsulated abscess; cultures obtained from the abscesses stained for gram positive bacteria. Conclusion Pituitary abscess is a rare, potentially life-threatening disorder that may be easily mistaken for other sellar lesions. In this review, we contribute two additional cases of pituitary abscesses to increase awareness and emphasize the importance of proper diagnosis and management.

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