Spontaneous rupture of a secondary pituitary abscess causing acute meningoencephalitis: Case report and literature review

Muscas, Giovanni; Iacoangeli, F.; Lippa, Laura; Carangelo, B

doi:10.4103/sni.sni_131_17

Cited by 4 publications

(1 citation statement)

References 19 publications

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“…In this article, MRI images of one case showed severe inflammation in the mucosa of the sphenoid sinus at the bottom of the sellar. It has been reported that inflammation of the structures around the pituitary, such as sphenoid sinusitis, meningitis, and cavernous sinus thrombophlebitis, is one of the causes of pituitary abscess [18][19][20][21]. This type of abscess is called a primary pituitary abscess.…”

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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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: a case report and systematic review of 488 cases

Stringer

Foong

Tan

et al. 2023

Orphanet J Rare Dis

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Background Pituitary abscess (PA) is a rare condition and not well understood. We aimed to describe a case and perform a comprehensive systematic review to explore presenting symptoms, radiological findings, endocrine abnormalities and mortality. Aim To identify presenting symptoms, radiological findings, endocrinological abnormalities and predictors of mortality for PA. Methods We systematically reviewed the literature to identify all case reports of PA. Data regarding presentation, mortality, radiological findings, endocrinological abnormalities and treatment was extracted. Results We identified 488 patients from 218 articles meeting the inclusion criteria. Mortality was 5.1%, with days to presentation (OR 1.0005, 95% CI 1.0001–1.0008, p < 0.01) being the only identified independent predictor of mortality. Mortality rates have decreased over time, with cases published prior to 2000 having higher mortality rates (OR 6.92, 95% CI 2.80–17.90, p < 0.001). The most common symptom was headache (76.2%), followed by visual field defects (47.3%). Classical signs of infection were only present in 43%. The most common imaging feature on magnetic resonance imaging (MRI) was high T2 and low T1 signal of the pituitary gland with peripheral contrast enhancement. Over half (54.8%) were culture negative, with the most common bacterial organism being staphylococcus aureus (7.8%) and fungal organism being aspergillus (8.8%). The most common endocrine abnormality was hypopituitarism (41.1%), followed by diabetes insipidus (24.8%). Whilst symptoms resolved in most patients, persistent endocrine abnormalities were present in over half of patients (61.0%). Conclusion PA is associated with significant mortality, with delayed presentation increasing risk of mortality. Ongoing endocrinological abnormalities are common. Given the non-specific clinical presentation, the appearance of high T2, low T1 and peripheral contrast enhancement of the pituitary on MRI should prompt consideration of this rare disease.

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Pituitary abscess: A case report and systematic review of 488 cases

Stringer

Foong

Tan

et al. 2023

Preprint

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Background Pituitary abscess (PA) is a rare condition and not well understood. We aimed to describe a case and perform a comprehensive systematic review to explore presenting symptoms, radiological findings, endocrine abnormalities and mortality. Aim To identify presenting symptoms, radiological findings, endocrinological abnormalities and predictors of mortality for PA. Methods We systematically reviewed the literature to identify all case reports of PA. Data regarding presentation, mortality, radiological findings, endocrinological abnormalities and treatment was extracted. Results We identified 488 patients from 218 articles meeting the inclusion criteria. Mortality was 5.1%, with days to presentation (OR 1.0005, 95%CI 1.0001–1.0008, p < 0.01) being the only identified independent predictor of mortality. Mortality rates have decreased over time, with cases published prior to 2000 having higher mortality rates (OR 6.92, 95%CI 2.80–17.90, p < 0.001). The most common symptom was headache (76.2%), followed by visual field defects (47.3%). Classical signs of infection were only present in 43%. The most common imaging feature on magnetic resonance imaging (MRI) was high T2 and low T1 signal of the pituitary gland with peripheral contrast enhancement. Over half (54.8%) were culture negative, with the most common bacterial organism being staphylococcus aureus (7.8%) and fungal organism being aspergillus (8.8%). The most common endocrine abnormality was hypopituitarism (41.1%), followed by diabetes insipidus (24.8%). Whilst symptoms resolved in most patients, persistent endocrine abnormalities were present in over half of patients (61.0%). Conclusion PA is associated with significant mortality, with delayed presentation increasing risk of mortality. Ongoing endocrinological abnormalities are common. Given the non-specific clinical presentation, the appearance of high T2, low T1 and peripheral contrast enhancement of the pituitary on MRI should prompt consideration of this rare disease.

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Spontaneous rupture of a secondary pituitary abscess causing acute meningoencephalitis: Case report and literature review

Cited by 4 publications

References 19 publications

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

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

Pituitary abscess: a case report and systematic review of 488 cases

Pituitary abscess: A case report and systematic review of 488 cases

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