Unusual Presentation of Recurrent Pituitary Abscess

Bladowska, Joanna; Bednarek-Tupikowska, Grażyna; Sokolska, Violetta; Czapiga, E.; Czapiga, Bogdan; Sąsiadek, Marek

doi:10.1177/197140091002300509

Cited by 5 publications

(3 citation statements)

References 17 publications

(45 reference statements)

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“…Recurrent primary pituitary abscess is a very rare condition. To our knowledge, only 8 cases have been reported in the literature (excluding those secondary to previous pituitary surgery) ( Table 2 ) ( 2 , 3 , 4 , 5 , 6 , 7 , 8 ). Our clinical case highlights the difficulty to make this diagnosis before surgery due to its rarity and the nonspecific presentation, usually without systemic signs of infection.…”

Section: Discussionmentioning

confidence: 99%

Recurrent pituitary abscess: case report and review of the literature

Furnica

Lelotte

Duprez

et al. 2018

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryA 26-year-old woman presented with severe postpartum headaches. Magnetic resonance imaging (MRI) revealed a symmetric, heterogeneous enlargement of the pituitary gland. Three months later, she developed central diabetes insipidus. A diagnosis of postpartum hypophysitis was suspected and corticosteroids were prescribed. Six months later, the pituitary mass showed further enlargement and characteristics of a necrotic abscess with a peripheral shell and infiltration of the hypothalamus. Transsphenoidal surgery was performed, disclosing a pus-filled cavity which was drained. No bacterial growth was observed, except a single positive blood culture for Staphylococcus aureus, considered at that time as a potential contaminant. A short antibiotic course was, however, administered together with hormonal substitution for panhypopituitarism. Four months after her discharge, severe headaches recurred. Pituitary MRI was suggestive of a persistent inflammatory mass of the sellar region. She underwent a new transsphenoidal resection of a residual abscess. At that time, the sellar aspiration fluid was positive for Staphylococcus aureus and she was treated with antibiotics for 6 weeks, after which she had complete resolution of her infection. The possibility of a pituitary abscess, although rare, should be kept in mind during evaluation for a necrotic inflammatory pituitary mass with severe headaches and hormonal deficiencies.Learning points:The possibility of a pituitary abscess, although rare, should be kept in mind during evaluation for a necrotic inflammatory pituitary mass with severe headaches and hormonal deficiencies.In a significant proportion of cases no pathogenic organism can be isolated.A close follow-up is necessary given the risk of recurrence and the high rate of postoperative pituitary deficiencies.

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Section: Discussionmentioning

confidence: 99%

Recurrent pituitary abscess: case report and review of the literature

Furnica

Lelotte

Duprez

et al. 2018

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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“…However, the specifi city of such a pattern is not extremely high, since other pituitary disorders may have similar appearance on conventional images 7 . Advanced imaging techniques such as diff usion imaging have markedly improved the specifi city of MRI in diff erentiation between pituitary abscesses and tumors, since increase in diff usion signal and decrease of apparent diff usion coeffi cient are typical for abscesses, whereas necrotic masses show decreased signal on diff usion sequence and elevation of apparent diff usion coeffi cient 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Incomplete healing associated with proliferation of fi brous-granulation tissue, mimicking tumor, was evident in our patient. Recurrence of pituitary abscess has been reported in the literature 7,17 . However, to the best of our knowledge, there are no clinical or imaging reports of pituitary abscess recurrence with later consequent presence of marked amount of fi brous and granulation tissue associated with rare cellular elements, mimicking tumor.…”

Section: Fig 3 T1w Images Without (A) and With (B) Contrast Agent Tmentioning

confidence: 96%

Pituitary Abscess With Unusual Clinical Course

Medić-Stojanoska

Kozić

Bjelan

et al. 2016

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SUMMARY -Th e aim is to present unusual clinical course and magnetic resonance imaging (MRI) features of pituitary abscess. A 59-year-old man presented with fever, polyuria, polydipsia and marked weight loss within the last two months. Basic endocrinology tests revealed the presence of anterior pituitary dysfunction, associated with central diabetes insipidus and increased levels of infl ammatory markers. Th e presence of expansile sellar lesion, showing restricted diff usion signal pattern compatible with acute pituitary pyogenic abscess was found on MRI. Regression of pituitary abscess was obvious during the next few weeks of parenteral antibiotic treatment. Adequate substitution treatment with L thyroxine, hydrocortisone, testosterone and desmopressin was achieved. Seventeen months later, clinical deterioration associated with recurrent pituitary abscess was confi rmed on MRI. Abscess regression was obvious again after conservative treatment. However, control MRI study performed three years after initial scanning revealed the presence of pituitary tumor, most consistent with macroadenoma. Surgical intervention was ordered. Histologic evaluation indicated the presence of fi brotic changes, associated with granulation tissue and rare cellular elements, compatible with chronic infl ammation. To the best of our knowledge, there are no studies in the literature describing such a pattern of chronic evolution of pyogenic pituitary abscess with consequent chronic infl ammatory changes with granulation tissue proliferation, mimicking macroadenoma.

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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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Unusual Presentation of Recurrent Pituitary Abscess

Cited by 5 publications

References 17 publications

Recurrent pituitary abscess: case report and review of the literature

Recurrent pituitary abscess: case report and review of the literature

Pituitary Abscess With Unusual Clinical Course

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

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