Recurrent pituitary abscess: case report and review of the literature

Furnica, Raluca Maria; Lelotte, Julie; Duprez, Thierry; Maiter, Dominique; Alexopoulou, Orsalia

doi:10.1530/edm-17-0162

Cited by 8 publications

(8 citation statements)

References 18 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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“…Abscesses can develop from pituitary lesions such as cysts and tumors. In 50% to 70% of all cases, no cause for the abscess development can be found [ 45 ]. Furthermore in about 50% of the cases the causative pathogenic microorganisms cannot be isolated [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…Other authors believe that the “sterile” exudate is due to either inadequate bacterial tests for anaerobic microorganisms or previous antibiotic therapy [ 46 , 48 ]. The incidence of pituitary abscesses is generally given as less than 1% (0.2–1%) of pituitary lesions [ 45 ]. The German Pituitary Tumor Registry comprises 18,329 cases.…”

Section: Discussionmentioning

confidence: 99%

Typing of inflammatory lesions of the pituitary

et al. 2021

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Inflammatory pituitary lesions account for 1.8% of all specimens from the German Pituitary Tumor Registry. They occure in 0.5% of the autoptical specimens and in 2.2% of the surgical cases. Women are significantly more often affected than men and are often younger when first diagnosed. In general, primary and secondary inflammation can be distinguished, with secondary types occurring more frequently (75.1%) than idiopathic inflammatory lesions (15.4%). In primary inflammation, the lymphocytic type is more common (88.5%) than the granulomatous type of hypophysitis (11.5%). The most common causes of secondary inflammation are Rathke’s cleft cysts (48.6%), followed by tumors (17.4%) such as the craniopharyngioma (9.1%), adenoma (5.5%) or germinoma (2.0%). More causes are tumor-like lesions (7.1%) such as xanthogranuloma (3.5%) or Langerhans histiocytosis (3.5%), abscesses (5.5%), generalized infections (5.1%), spreaded inflammations (4.7%) and previous surgeries (4.0%). In 1.6% of all specimens the reason for the inflammation remains unclear. The described classification of hypophysitis is important for specific treatment planning after surgery.

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“…Three cases did not have a recurrence, and one case relapsed one year after surgery and recovered. Recurrence is considered to be related to persistently low hormone levels and insufficient drainage [23].…”

Section: Discussionmentioning

confidence: 99%

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

Wu¹,

Qiu²,

Lin³

et al. 2021

Journal of Integrative Neuroscience

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Pituitary abscess is a rare disease with a high preoperative misdiagnosis rate. Magnetic resonance imaging is the primary method for confirming pituitary abscesses before surgery. We reported magnetic resonance imaging findings of four cases of pituitary abscess (three males and one female) aged from 33 to 72 years old. All four cases underwent transnasal sphenoid surgery and had a good prognosis. The findings on magnetic resonance imaging were analyzed. Three cases showed ring enhancement of the capsule wall. Four cases showed thickened pituitary stalk, with the diameter of the lower end larger than that of the upper end. The position of the pituitary stalk where it was inserted into the upper edge of the pituitary was located at the middle and posterior 1/3 junction of the upper edge of the pituitary two cases were with the enhancement of the dura mater at the bottom of the temporal lobe. Two cases were with the enhancement of the dura mater of the petroclival region, and one case was with the enhancement of the cavernous sinus. There are few articles concerning abnormal magnetic resonance imaging around the sellar region of pituitary abscess. The findings of the four cases in this article suggest that the pituitary abscess has characteristic abnormal magnetic resonance imaging of the sellar region and its surroundings.

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Recurrent pituitary abscess: case report and review of the literature

Cited by 8 publications

References 18 publications

Pituitary Abscess: A Challenging Preoperative Diagnosis—A Multicenter Study

Pituitary Abscess: A Challenging Preoperative Diagnosis—A Multicenter Study

Typing of inflammatory lesions of the pituitary

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

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