1
|
Baskurt O, Baysoy Avinçsal B, Diren F, Kabatas S, Kusoglu H, Kara S, Gazioglu N. Secondary Pituitary Abscess: A Rare Complication of Transsphenoidal Surgery for Pituitary Adenoma - Description of Two New Cases and Review of the Literature. Surg Infect (Larchmt) 2024. [PMID: 39058677 DOI: 10.1089/sur.2024.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Abstract
Background: Pituitary abscess (PA), a rare complication following transsphenoidal (TS) surgery for pituitary adenoma with an incidence of 0.2%, poses a significant risk; carrying potential morbidity, recurrence, and the necessity for reoperation. Timely suspicion, diagnosis, and treatment are imperative. Patients and Methods: We present two cases and provide a literature review on the symptoms, risk factors, diagnosis, treatment, and outcomes associated with secondary PAs following TS surgery for adenoma. Results: We identified 12 articles reporting a total of 45 cases, in addition to our 2 cases. The primary symptoms were headache and visual impairment, with no fever or specific infectious parameters observed. Predominant risk factors identified included cerebrospinal fluid (CSF) leakage and prior radiotherapy (RT). Our first patient, a 45-year-old male, presented 10 weeks after TS surgery with sudden-onset symptoms, whereas our second patient, a 64-year-old female, presented 22 years postoperatively. In the first case, intraoperative CSF leakage, with the patient's history of allergic rhinitis and frequent nasal irrigation possibly contributed to the development of abscess. In the second case, RT was considered a potential risk factor. Severe headache and subclinical signs of infection associated with a cystic lesion of the pituitary gland were common findings. Both patients underwent endoscopic TS drainage and received appropriate antibiotic therapy, resulting in complete recovery without recurrence. Conclusions: When faced with severe headaches in a patient with a history of TS surgery for a pituitary adenoma, coupled with radiological evidence showing a cystic appearance with peripheral enhancement, taking a proactive approach to promptly identify and intervene in secondary PAs is essential for mitigating potential complications and optimizing patient outcomes.
Collapse
Affiliation(s)
- Ozan Baskurt
- Department of Neurosurgery, Faculty of Medicine, Istinye University, Istanbul, Türkiye
- Liv Hospital Vadistanbul, Istanbul, Türkiye
| | - Benan Baysoy Avinçsal
- Department of Neurosurgery, Gaziosmanpasa Research and Training Hospital, Istanbul, Türkiye
| | - Furkan Diren
- Department of Neurosurgery, Gaziosmanpasa Research and Training Hospital, Istanbul, Türkiye
| | - Serdar Kabatas
- Department of Neurosurgery, Gaziosmanpasa Research and Training Hospital, Istanbul, Türkiye
| | - Hulya Kusoglu
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Türkiye
| | - Simay Kara
- Department of Radiology, Faculty of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Türkiye
| | - Nurperi Gazioglu
- Department of Neurosurgery, Faculty of Medicine, Istinye University, Istanbul, Türkiye
- Liv Hospital Vadistanbul, Istanbul, Türkiye
| |
Collapse
|
2
|
Xue Q, Shi X, Fu X, Yin Y, Zhou H, Liu S, Sun Q, Meng J, Bian L, Tan H, He H. Pituitary abscess: a descriptive analysis of a series of 19 patients-a multi-center experience. Eur J Med Res 2024; 29:262. [PMID: 38698484 PMCID: PMC11067254 DOI: 10.1186/s40001-024-01749-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 02/26/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES Pituitary abscess (PA) accounts for only 0.3-0.5% of sellar masses, and the lack of specific clinical symptoms makes diagnosing PA difficult without a surgical biopsy. In clinical practice, PA is often mistaken for cystic pituitary adenoma, craniopharyngioma, and Rathke's cyst. Thus, this study aims to investigate challenges in diagnosing PA and evaluate the importance of combining intraoperative surgery with postoperative antibiotic treatment. METHODS We conducted a retrospective analysis of 19 patients diagnosed with PA through histopathology. All patients underwent transsphenoidal surgery (TSS) for pituitary adenomas after undergoing comprehensive preoperative evaluations, including routine tests, endocrine assay, and imaging examination. Furthermore, we compared different treatments for pituitary abscess (PA) to determine the most effective approach for achieving a favorable prognosis. RESULTS The most prevalent symptom of PA was headache, especially in the frontal-temporal and vertex regions, ranging from mild to moderate severity. Hypopituitarism-related symptoms were also frequently observed, including hypaphrodisia, cold sensitivity, fatigue, weight loss, polyuria, and amenorrhea. Twelve patients exhibited abnormalities in endocrinology examinations. Diagnosing PA correctly is challenging. In our study, none of the patients were correctly diagnosed with PA prior to surgery, and many sellar lesions were misdiagnosed. The favorable prognosis was largely attributed to surgical intervention and active postoperative antibiotic therapy. CONCLUSIONS Given the lack of clarity in preoperative diagnosis, typical intraoperative findings and effective antibiotics treatment are more indicative of the correct diagnosis than other tests. In terms of therapy, optimal surgical intervention and active postoperative antibiotic treatment contribute to resolving the challenges posed by PA.
Collapse
Affiliation(s)
- Qiang Xue
- Departments of Neurosurgery, The Third Affiliated Hospital, Naval Medical University, Shanghai, 200438, China
| | - Xiuhua Shi
- Department of Radiotherapy & Oncology, The No. 2 People's Hospital of Wuhu City, Wuhu, Anhui, China
| | - Xiaoling Fu
- Department of Medical Psychology, The Fourth Medical Center of PLA General Hospital, 51 Fu Cheng Road, Beijing, 100048, China
| | - Yating Yin
- Departments of Neurosurgery, The Third Affiliated Hospital, Naval Medical University, Shanghai, 200438, China
| | - Hui Zhou
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Suiyi Liu
- Department of Medical Engineering, Third Affiliated Hospital of Navy Military Medical University, Shanghai, 200438, China
| | - Qingfang Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Rui Jin Er Road, Shanghai, 200025, China
| | - Jin Meng
- Institute of Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Liuguan Bian
- Department of Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Rui Jin Er Road, Shanghai, 200025, China.
| | - Hong Tan
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Hua He
- Departments of Neurosurgery, The Third Affiliated Hospital, Naval Medical University, Shanghai, 200438, China.
| |
Collapse
|
3
|
Ghosh SR, Pecorari IL, Funari A, Ledet AJ, Lally A, Karandish A, Agarwal V. Primary Pituitary Abscess: Two Case Reports. J Neurol Surg Rep 2024; 85:e53-e58. [PMID: 38665392 PMCID: PMC11045293 DOI: 10.1055/a-2297-3909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/21/2023] [Indexed: 04/28/2024] Open
Abstract
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. Magnetic resonance imaging (MRI) showed a large sellar mass measuring 2.5 cm × 1.8 cm × 1.6 cm (CC × XT × 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 × 1.2 cm × 1.5 cm (XT × CC × 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.
Collapse
Affiliation(s)
- Sayak R. Ghosh
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Isabella L. Pecorari
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Abigail Funari
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Alexander J. Ledet
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Anne Lally
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Alireza Karandish
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Vijay Agarwal
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| |
Collapse
|
4
|
Inoue E, Kesumayadi I, Fujio S, Makino R, Hanada T, Masuda K, Higa N, Kawade S, Niihara Y, Takagi H, Kitazono I, Takahashi Y, Hanaya R. Secondary hypophysitis associated with Rathke's cleft cyst resembling a pituitary abscess. Surg Neurol Int 2024; 15:69. [PMID: 38468645 PMCID: PMC10927231 DOI: 10.25259/sni_947_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024] Open
Abstract
Background Although rare, cases of hypophysitis resembling a pituitary abscess (PA) have been reported. Differential diagnosis between hypophysitis and PA is crucial as the two diseases require different treatments. Case Description A 38-year-old woman with headaches underwent head magnetic resonance imaging (MRI), which revealed an 11-mm mass lesion in the sella turcica. Due to breastfeeding, contrast-enhanced MRI was avoided. Pituitary adenomas and Rathke's cleft cyst (RCC) were suspected, and she was initially treated conservatively. Five months later, she acquired syndrome coronavirus two infections, and while the fever subsided with acetaminophen, the headache persisted. One month later, the headache worsened, followed by fever and diabetes insipidus. MRI revealed a pituitary cystic mass with ring-shaped contrast enhancement on T1-weighted MRI and increased signal intensity on diffusion-weighted imaging (DWI). PA was suspected, and emergency endoscopic transsphenoidal surgery was performed. The microbiological examination of the yellowish-brown content drained from the cystic mass was negative. Microscopically, the cystic lesion was covered with ciliated columnar epithelium and stratified squamous epithelium, with a dense inflammatory cell infiltrate consisting mainly of lymphocytes and plasma cells observed around the cyst. This supported the diagnosis of secondary hypophysitis associated with RCC without PA. Conclusion We report a case of hypophysitis secondary to RCC resembling PA with ring-shaped contrast enhancement on MRI and increased signal intensity on DWI. This case emphasizes the need for cautious diagnosis of secondary hypophysitis due to RCC in individuals with MRIs and clinical manifestations resembling an abscess.
Collapse
Affiliation(s)
- Eri Inoue
- Department of Neurosurgery, Kagoshima University, Kagoshima, Japan
| | - Irfan Kesumayadi
- Department of Neurosurgery, Kagoshima University, Kagoshima, Japan
- Department of Neurosurgery, Diponegoro University, Tembalang, Semarang, Indonesia
| | - Shingo Fujio
- Department of Neurosurgery, Kagoshima University, Kagoshima, Japan
- Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Ryutaro Makino
- Department of Neurosurgery, Kagoshima University, Kagoshima, Japan
- Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Tomoko Hanada
- Department of Neurosurgery, Kagoshima University, Kagoshima, Japan
- Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Keisuke Masuda
- Department of Neurosurgery, Kagoshima University, Kagoshima, Japan
| | - Nayuta Higa
- Department of Neurosurgery, Kagoshima University, Kagoshima, Japan
| | - Shigeru Kawade
- Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan
- Department of Diabetes and Endocrine Medicine, Kagoshima University, Kagoshima, Japan
| | - Yuichiro Niihara
- Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan
- Department of Obstetrics and Gynecology, Kagoshima University, Kagoshima, Japan
| | - Hirosuke Takagi
- Department of Hematology and Rheumatology, Kagoshima University, Kagoshima, Japan
| | - Ikumi Kitazono
- Department of Pathology, Kagoshima University, Kagoshima, Japan
| | - Yutaka Takahashi
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Ryosuke Hanaya
- Department of Neurosurgery, Kagoshima University, Kagoshima, Japan
| |
Collapse
|
5
|
Stringer F, Foong YC, Tan A, Hayman S, Zajac JD, Grossmann M, Zane JNY, Zhu J, Ayyappan S. Pituitary abscess: a case report and systematic review of 488 cases. Orphanet J Rare Dis 2023; 18:165. [PMID: 37365629 DOI: 10.1186/s13023-023-02788-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Felicity Stringer
- Barwon Health, Geelong, VIC, Australia
- St Vincent's Health, Melbourne, VIC, Australia
| | - Yi Chao Foong
- Barwon Health, Geelong, VIC, Australia.
- Monash Health, Melbourne, VIC, Australia.
- Alfred Health, Melbourne, VIC, Australia.
- Eastern Health, Melbourne, VIC, Australia.
| | - Alanna Tan
- Austin Health, Melbourne, VIC, Australia
| | | | | | | | - Justin Ng Yau Zane
- Monash Health, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
- Royal Hobart Hospital, Hobart, TAS, Australia
| | | | | |
Collapse
|
6
|
Rabiei MM, Ebrahimzadeh K, Davoudi Z, Bidari Zerehpoosh F, Javandoust Gharehbagh F, Sedaghati R, Lotfollahi L, Kalhor F, Alavi Darazam I. A case of pituitary gland abscess associated with granulomatous hypophysitis. BMC Neurol 2023; 23:11. [PMID: 36631799 PMCID: PMC9835326 DOI: 10.1186/s12883-023-03060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Granulomatous hypophysitis is a rare disease that presents with chronic inflammation of the pituitary gland. In this study, we reported a case of granulomatous hypophysitis associated with a pituitary abscess. CASE PRESENTATION A 39-year-old woman presented with a 2-year history of infertility. For the past six months, she has suffered from amenorrhea, decreased libido, headaches, and vertigo. She was referred to our hospital with a suspected diagnosis of nonfunctioning pituitary adenoma based on her presentation and brain MRI findings. She underwent trans-sphenoidal surgery (TSS). Direct observation during surgery revealed drainage of malodor pus and pituitary gland abscess. The histopathological evaluation also showed granulomatous hypophysitis and neutrophilic microabscess formation. The patient was initially treated with high doses of ceftriaxone (2 g twice daily) and metronidazole (500 mg (mg) four times per day). Also, the patient received cortisol replacement therapy after the operation. After obtaining the antibiogram and culture results, the treatment regimen was continued for 4 weeks postoperatively, followed by amoxicillin-clavulanate (500/125 mg three times daily) for a total duration of 12 weeks. CONCLUSION The patient recovered uneventfully and the postoperative MRI was normal without any remnant lesions.
Collapse
Affiliation(s)
- Mohammad Mahdi Rabiei
- grid.411600.2Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Ebrahimzadeh
- grid.411600.2Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Davoudi
- grid.411600.2Department of Endocrinology, Skull Base Research Center of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farahnaz Bidari Zerehpoosh
- grid.411600.2Department of Pathology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Javandoust Gharehbagh
- grid.411600.2Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roghayeh Sedaghati
- grid.411600.2Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Legha Lotfollahi
- grid.411600.2Department of Nephrology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Kalhor
- grid.411600.2Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ilad Alavi Darazam
- grid.411600.2Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,grid.411600.2Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
Warda F, Patel J, Shahla L. Pituitary Abscess Causing Hypopituitarism in a Patient With Acquired Immunodeficiency Syndrome. AACE Clin Case Rep 2022; 8:243-246. [DOI: 10.1016/j.aace.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/06/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022] Open
|
8
|
Oktay K, Guzel E, Yildirim DC, Aliyev A, Sari I, Guzel A. Primary pituitary abscess mimicking meningitis in a pediatric patient. Childs Nerv Syst 2021; 37:3241-3244. [PMID: 33523244 DOI: 10.1007/s00381-021-05063-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Pituitary abscess is a rare lesion of the pituitary gland that can cause morbidity and mortality in the absence of appropriate treatment. They are classified as primary and secondary pituitary abscesses. Primary pituitary abscesses occur in patients with no previous pituitary pathology. Secondary pituitary abscesses are detected in patients with existing pituitary pathologies. CASE PRESENTATION We report a 16-year-old female patient with primary pituitary abscess who was misdiagnosed initially and treated as meningitis. Following the visual disturbances, pituitary abscess was diagnosed, and she underwent abscess drainage via endoscopic endonasal transsphenoidal surgery and antibiotic treatment. CONCLUSION Primary pituitary abscess can be clinically confused with other pathologies affecting the central nervous system. In order to avoid permanent sequelae in such patients, it should be kept in mind by physicians in similar cases. Satisfying results are obtained in these patients after appropriate treatment and dramatic improvement is achieved.
Collapse
Affiliation(s)
- Kadir Oktay
- Department of Neurosurgery, Cukurova University School of Medicine, Saricam District, Balcali Campus, 01000, Adana, Turkey.
| | - Ebru Guzel
- Department of Radiology, Gaziantep Medical Park Hospital, Gaziantep, Turkey
| | - Dogu Cihan Yildirim
- Department of Neurosurgery, Cukurova University School of Medicine, Saricam District, Balcali Campus, 01000, Adana, Turkey
| | - Araz Aliyev
- Department of Neurosurgery, Cukurova University School of Medicine, Saricam District, Balcali Campus, 01000, Adana, Turkey
| | - Ibrahim Sari
- Department of Pathology, Patomer Pathology Laboratory, Gaziantep, Turkey
| | - Aslan Guzel
- Department of Neurosurgery, Bahcesehir University School of Medicine, İstanbul, Turkey
| |
Collapse
|
9
|
Aranda F, García R, Guarda FJ, Nilo F, Cruz JP, Callejas C, Balcells ME, González G, Rojas R, Villanueva P. Rathke's cleft cyst infections and pituitary abscesses: case series and review of the literature. Pituitary 2021; 24:374-383. [PMID: 33433887 DOI: 10.1007/s11102-020-01115-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Pituitary abscesses (PAs) are a rare clinical entity which may arise from normal pituitary tissue or underlying lesions within the gland. Rathke's cleft cysts (RCCs) are not commonly associated with the development of PA. METHODS Retrospective chart review of three patients with PAs within RCCs at a single university center and review of the literature. RESULTS Three cases are reported. The first case presented with fever and headache and a history of prior surgery due to RCC and a recent respiratory tract infection. The second case had a history of recent skin infections and presented with sudden onset headache and hypopituitarism. In the third case, chronic visual field impairment prompted an ophthalmologic evaluation resulting in a diagnosis of an adenoma and an infected RCC. In all three cases, an endoscopic endonasal approach was performed to drain infected tissue and allowed microbiological identification of gram-positive cocci, followed by treatment with antibiotics for at least three weeks. Cases in the literature are scarce and the diagnosis is usually made intraoperatively due to non-specific manifestations and imaging. PAs arising from underlying pituitary lesions are less common than primary PAs. Differential diagnosis should include pituitary apoplexy, hypophysitis and other cystic lesions. CONCLUSION PAs occurring in RCCs are infrequent. Clinical manifestations are commonly subacute, without septic symptoms. Imaging is usually non-specific. Preoperative diagnosis is infrequent and a broad differential diagnosis should be considered. Empirical antimicrobial therapy should be initiated and adjusted after obtaining cultures to reduce the rate of recurrence and improve clinical outcomes.
Collapse
Affiliation(s)
- F Aranda
- Neurosurgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R García
- Endocrinology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F J Guarda
- Endocrinology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Pituitary Tumor Program, Red de Salud UC-CHRISTUS, Santiago, Chile
- Center for Translational Endocrinology (CETREN), School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Nilo
- Endocrinology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Pituitary Tumor Program, Red de Salud UC-CHRISTUS, Santiago, Chile
- Center for Translational Endocrinology (CETREN), School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J P Cruz
- Pituitary Tumor Program, Red de Salud UC-CHRISTUS, Santiago, Chile
- Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Callejas
- Pituitary Tumor Program, Red de Salud UC-CHRISTUS, Santiago, Chile
- Otorhinolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M E Balcells
- Department of Infectious Diseases, School of Medicine, PontificiaUniversidad Católica de Chile, Santiago, Chile
| | - G González
- Endocrinology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for Translational Endocrinology (CETREN), School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Rojas
- Neurosurgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Villanueva
- Neurosurgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Pituitary Tumor Program, Red de Salud UC-CHRISTUS, Santiago, Chile.
| |
Collapse
|
10
|
Angelousi A, Mytareli C, Xekouki P, Kassi E, Barkas K, Grossman A, Kaltsas G. Diabetes insipidus secondary to sellar/parasellar lesions. J Neuroendocrinol 2021; 33:e12954. [PMID: 33769630 DOI: 10.1111/jne.12954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/24/2021] [Accepted: 02/09/2021] [Indexed: 12/25/2022]
Abstract
Diabetes insipidus (DI) is a well-recognised transient or permanent complication following transsphenoidal surgery for pituitary adenomas or other sellar/parasellar lesions. However, data regarding the prevalence of pre-operative DI in sellar/parasellar lesions other than pituitary adenomas are scarce. We systematically reviewed the existing data for defining the prevalence of DI before any treatment in adult patients with sellar/parasellar lesions, excluding pituitary adenomas and metastatic lesions. In total, 646 patients with sellar/parasellar lesions presenting with DI at diagnosis were identified. The most common pathologies of sellar/parasellar lesions presenting with DI at diagnosis were lymphocytic hypophysitis (26.5%), craniopharyngiomas (23.4%), Langerhans's cell histiocytosis (18.9%) and Rathke's cleft cyst (12.7%), accounting for the vast majority (more than 80%) of these lesions. Overall, DI at diagnosis was found in 23.4% of all patients with sellar/parasellar lesions, albeit with a wide range from 10.6% to 76.7%, depending on the nature of the pathology. The highest prevalence of DI was found in less commonly encountered lesions namely germ-cell tumours (76.7%), abscesses (55.4%) and neurosarcoidosis (54.5%), each accounting for less than 3% of all sellar/parasellar lesions. Most DI cases (68.8%) were associated with anterior pituitary hormonal deficiencies, in contrast to pituitary adenomas that rarely present with DI. The enlargement and enhancement of the pituitary stalk were the most common findings on magnetic resonance imaging besides the loss of the high signal of the posterior pituitary on T1-weighted images. Resolution of DI spontaneously or following systemic and surgical management occurred in 22.4% of cases. Post-operative DI, not evident before surgery, was found in 27.8% of non-adenomatous sellar/parasellar lesions, and was transient in 11.6% of them. Besides distinctive imaging features and symptoms, early recognition of DI in such lesions is important because it directs the diagnosis towards a non-adenomatous sellar/parasellar tumour and the early initiation of appropriate treatment.
Collapse
Affiliation(s)
- Anna Angelousi
- 1st Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysoula Mytareli
- 1st Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Xekouki
- Endocrinology and Diabetes Clinic, University General Hospital of Heraklion, Heraklion, Greece
| | - Eva Kassi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- 1st Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Barkas
- Department of Neurosurgery, General Hospital of Nikaia-Pireas, Agios Panteleimon, Athens, Greece
| | - Ashley Grossman
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
- Centre for Endocrinology, Barts and the London School of Medicine, London, UK
| | - Gregory Kaltsas
- 1st Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
11
|
Secondary Pituitary Abscess Inside Adenoma: A Case Report and Review of Literature. World Neurosurg 2020; 137:281-285. [PMID: 32081825 DOI: 10.1016/j.wneu.2020.02.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pituitary abscesses within pre-existing pituitary conditions, such as craniopharyngioma, pituitary adenoma, or Rathke cleft cyst, are quite rare. A case of pituitary abscess secondary to adenoma is presented, and the literature is reviewed. CASE DESCRIPTION An 11-year-old boy presented with a 3-day history of sudden-onset headache and visual loss. Magnetic resonance imaging demonstrated a sellar region lesion with intralesional hemorrhage. Preoperative diagnosis was pituitary adenoma with apoplexy. An endoscopic transnasal transsphenoidal approach was used for emergent total tumor resection. Pathology confirmed the diagnosis of pituitary adenoma with apoplexy and inflammation, and microbiologic examination was positive for Staphylococcus aureus. CONCLUSIONS Secondary pituitary abscess is a rare entity, and preoperative diagnosis is challenging. The treatment strategy includes prompt surgical resection and drainage of the abscess, followed by prolonged antibiotic therapy.
Collapse
|
12
|
Nordjoe YE, Aubin Igombe SR, Laamrani FZ, Jroundi L. Pituitary abscess: two case reports. J Med Case Rep 2019; 13:342. [PMID: 31759391 PMCID: PMC6875087 DOI: 10.1186/s13256-019-2280-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 10/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pituitary abscess is a rare condition with nonspecific symptoms that can be delayed. Proper diagnosis needs to occur preoperatively so that the management can be set up accordingly. Accurate diagnosis is challenging because many differential diagnoses can exhibit the same magnetic resonance imaging features. CASE PRESENTATION We report two cases of pituitary abscess. The first patient was a 66-year-old Arab woman who underwent a surgical procedure for a pituitary macroadenoma and presented 3 months later with chronic headaches and panhypopituitarism. A pituitary abscess was found on the follow-up magnetic resonance imaging. The second patient was a 64-year-old Arab man with no medical history who presented with a chiasmal syndrome with headaches and panhypopituitarism. Brain magnetic resonance imaging showed a heterogeneous pituitary mass that turned out to be a pituitary abscess intraoperatively. These two patients were treated with hormone substitution, endoscopic transsphenoidal drainage, and antibiotherapy, with excellent outcomes. CONCLUSIONS Pituitary abscess is a rare and serious condition. Preoperative diagnosis can be challenging because of the many existing differential diagnoses upon imaging. Magnetic resonance imaging is the mainstay technique of imaging due to its multimodal nature. These cases demonstrate the variable patterns of a pituitary abscess seen on magnetic resonance imaging and the potential difficulties in achieving an accurate diagnosis preoperatively due to many other conditions potentially exhibiting the same magnetic resonance imaging features.
Collapse
Affiliation(s)
- Yaotse Elikplim Nordjoe
- Radiology Department, Centre Hospitalo-Universiataire Ibn Sina, Rabat, Morocco. .,, Temara, Morocco.
| | | | | | - Laila Jroundi
- Radiology Department, Centre Hospitalo-Universiataire Ibn Sina, Rabat, Morocco
| |
Collapse
|
13
|
Li Z, Yang C, Bao X, Yao Y, Feng M, Deng K, Liu X, Xing B, Wang R. Clinical Features and Treatment of Secondary Pituitary Abscess After Transsphenoidal Surgery: A Retrospective Study of 23 Cases. World Neurosurg 2018; 113:e138-e145. [DOI: 10.1016/j.wneu.2018.01.197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/27/2018] [Accepted: 01/29/2018] [Indexed: 01/26/2023]
|
14
|
Muscas G, Iacoangeli F, Lippa L, Carangelo BR. Spontaneous rupture of a secondary pituitary abscess causing acute meningoencephalitis: Case report and literature review. Surg Neurol Int 2017; 8:177. [PMID: 28868189 PMCID: PMC5569396 DOI: 10.4103/sni.sni_131_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/20/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pituitary abscess (PA) is an uncommon finding that is rarely diagnosed preoperatively. If not properly treated it is associated with high morbidity and mortality rates. Nowadays standard diagnostic procedures allow early detection and successful treatment of this lesion in a high number of cases and mortality has been significantly reduced in recent years. PA arising de novo in a healthy gland are defined as primary, whereas those complicating a pre-existing disease of the hypophysis are called secondary abscesses. CASE DESCRIPTION We present a case of a secondary PA mimicking a large pituitary adenoma extending in the nasal cavity, which was wrongly diagnosed as such. The abscess showed an unexpected evolution in 48 h from presentation due to a sudden, extensive intracranial leakage of pus. CONCLUSIONS To our knowledge, it is rare to find PA showing a rapid evolution like this, and in the literature only one previous case of a PA not reaching medical or surgical therapy was reported. In that case, hypothalamus involvement was identified as the cause of death. This should be the first case reported of a spontaneous PA rupture causing acute meningoencephalitis. Along with a short review of the literature on the major features of PA, we also tried to identify some features which could be supportive of a diagnosis of secondary PA.
Collapse
Affiliation(s)
- Giovanni Muscas
- Department of Neurosurgery, Careggi Hospital, Florence, Italy.,School of Neurosurgery, University of Florence, Florence, Italy
| | - Francesco Iacoangeli
- Department of Neurosurgery, Le Scotte Hospital, Siena.,School of Neurosurgery, University of Florence, Florence, Italy
| | - Laura Lippa
- Department of Neurosurgery, Le Scotte Hospital, Siena.,School of Neurosurgery, University of Florence, Florence, Italy
| | | |
Collapse
|
15
|
Abstract
Pituitary abscess is an uncommon pituitary lesion. Its clinical diagnosis can be difficult to distinguish from other pituitary lesions. This pathology is characterised by vague symptoms of headaches, generalised tiredness and hypopituitarism manifestations. A history of recent meningitis, paranasal sinusitis or head surgery can be a suggestive of the source of infection. A 20-year-old man was admitted to neurosurgery department with complain of headache, fatigue, polyuria, polydipsia, blurred vision and sexual dysfunction. MRI of the head revealed a suprasellar mass that was centrally hyperintense lesion on T2-weighted images with peripheral hypointensity and isointense centrally on T1 images with peripheral hyperintensity images. Treatment of this lesion pituitary abscess was surgical drainage of the pituitary area through a trans-sphenoidal approach and broad spectrum antibiotic therapy with ceftriaxone, metronidazole and vancomycin for 6 weeks. The patient continues to have pituitary insufficiency and treated with oral hydrocortisone. Although pituitary abscess is a rare condition, it should always be kept in mind when evaluating a patient with hypopituitarism. After the diagnosis, the surgery and antibiotics should be commenced rapidly. The outcome is usually good with proper treatment.
Collapse
Affiliation(s)
| | | | - Mohamed Helmy
- Department of Neurosciences, Salmaniya Medical Complex, Manama, Bahrain
| |
Collapse
|
16
|
Sun H, Samra NS, Kalakoti P, Sharma K, Patra DP, Dossani RH, Thakur JD, Disbrow EA, Phan K, Veeranki SP, Pabaney A, Notarianni C, Owings JT, Nanda A. Impact of Prehospital Transportation on Survival in Skiers and Snowboarders with Traumatic Brain Injury. World Neurosurg 2017; 104:909-918.e8. [PMID: 28559075 DOI: 10.1016/j.wneu.2017.05.108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Prehospital helicopter use and its impact on outcomes in snowboarders and skiers incurring traumatic brain injury (TBI) is unknown. The present study investigates the association of helicopter transport with survival of snowboarders and skiers with TBI, in comparison with ground emergency medical services (EMS), by using data derived from the National Trauma Data Bank (2007-2014). METHODS Primary and secondary endpoints were defined as in-hospital survival and absolute risk reduction based upon number needed to transport (treat) respectively. Multivariable regression models including traditional logit model, model fitted with generalized estimating equations, and those incorporating results from propensity score matching methods were used to investigate the association of helicopter transport with survival compared with ground EMS. RESULTS Of the 1018 snowboarders and skiers who met the criteria, 360 (35.4%) were transported via helicopters whereas 658 (64.6%) via ground EMS with a mortality rate of 1.7% and 1.5%, respectively. Multivariable log-binomial models demonstrated association of prehospital helicopter transport with increased survival (odds ratio 8.58; 95% confidence interval 1.09-67.64; P = 0.041; absolute risk reduction: 10.06%). This finding persisted after propensity score matching (odds ratio 24.73; 95% confidence interval 5.74-152.55; P < 0.001). The corresponding absolute risk reduction implies that approximately 10 patients need to be transported via helicopter to save 1 life. CONCLUSIONS Based on our robust statistical analysis of retrospective data, our findings suggest prehospital helicopter transport improved survival in patients incurring TBI after snowboard- or ski-related falls compared with those transported via ground EMS. Policies directed at using helicopter services at remote winter resorts or ski or snowboarding locations should be implemented.
Collapse
Affiliation(s)
- Hai Sun
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
| | - Navdeep S Samra
- Department of Trauma and Surgical Critical Care, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Piyush Kalakoti
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Kanika Sharma
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Devi Prasad Patra
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Rimal H Dossani
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Jai Deep Thakur
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Elizabeth A Disbrow
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Barker St. Randwick, Prince of Wales Private Hospital, Sydney, Australia
| | - Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Galveston, Texas, USA
| | - Aqueel Pabaney
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Christina Notarianni
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - John T Owings
- Department of Trauma and Surgical Critical Care, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| |
Collapse
|
17
|
Agyei JO, Lipinski LJ, Leonardo J. Case Report of a Primary Pituitary Abscess and Systematic Literature Review of Pituitary Abscess with a Focus on Patient Outcomes. World Neurosurg 2017; 101:76-92. [DOI: 10.1016/j.wneu.2017.01.077] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/16/2017] [Accepted: 01/19/2017] [Indexed: 11/28/2022]
|
18
|
Gao L, Guo X, Tian R, Wang Q, Feng M, Bao X, Deng K, Yao Y, Lian W, Wang R, Xing B. Pituitary abscess: clinical manifestations, diagnosis and treatment of 66 cases from a large pituitary center over 23 years. Pituitary 2017; 20:189-194. [PMID: 27696121 DOI: 10.1007/s11102-016-0757-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Pituitary abscess (PA) is rare and commonly described in case reports or small case series. This study aimed to better determine salient clinical manifestations related to the diagnosis and appropriate treatment of PA using by far the largest case series of this disease. METHODS A total of 6361 consecutive patients underwent surgery for pituitary diseases in Peking Union Medical College Hospital between January 1991 and December 2013. Among this cohort, sixty-six patients were diagnosed with PA based on both intraoperative findings and postoperative histopathological evidence. RESULTS The most common clinical presentation was anterior pituitary hypofunction (81.8 %), followed by common headache (69.7 %), diabetes insipidus (DI; 47.9 %), visual disturbances (45.5 %) and symptoms related to infection (43.9 %). Forty patients (66.7 %) showed typical rim enhancement after gadolinium injection on magnetic resonance imaging (MRI). Most patients (63 of 66, 95.5 %) underwent transsphenoidal surgery (TSS), and the remaining 3 patients (4.5 %) were treated with transcranial surgery (TC). After follow-up for 7.2 ± 4.9 years, PA was diminished in most patients (81.8 %), as demonstrated by post-operative MRI, and eight patients underwent at least one additional operation due to recurrence. CONCLUSIONS For patients with hypopituitarism and DI with rim enhancement on MRI, we should consider the possible diagnosis of PA. Proper use of antibiotics, complete drainage via surgery and hormone replacement for hypopituitarism are the key treatments for PA.
Collapse
Affiliation(s)
- Lu Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China
| | - Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China
| | - Rui Tian
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China
| | - Qiang Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China
| | - Xinjie Bao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China
| | - Kan Deng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China
| | - Wei Lian
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.
- China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
| |
Collapse
|
19
|
Shi L, Zhou M, Xu S, Wu Q, Yan W, Zhang J. Endovascular Treatment of Intracavernous Internal Carotid Aneurysm Secondary to Pituitary Infection. World Neurosurg 2017; 101:816.e5-816.e9. [PMID: 28238872 DOI: 10.1016/j.wneu.2017.02.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/11/2017] [Accepted: 02/15/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intracavernous internal carotid artery (ICICA) aneurysm secondary to pituitary infection is exceedingly rare. CASE DESCRIPTION We report an unusual case of a 63-year-old man who presented with acute left blepharoptosis and imaging findings of a pituitary infection. Interestingly, sudden onset of right blepharoptosis occurred after anti-infective therapy for 10 days. Digital subtraction angiography revealed a right ICICA aneurysm. After 6 months of follow-up visits, enlargement of the ICICA aneurysm was observed, and the endovascular technique of a low-profile visualized intraluminal support stent combined with 5 detachable coils was successfully performed to treat the ICICA aneurysm, with preservation of the internal carotid artery. CONCLUSION This rare case highlights a life-threatening complication of a pituitary infection. Moreover, enlargement of the infected ICICA aneurysm could not be relieved by conservative anti-infective therapy. Endovascular treatment may be an alternative therapy for an infected ICICA aneurysm.
Collapse
Affiliation(s)
- Ligen Shi
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Mading Zhou
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shenbin Xu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qun Wu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Yan
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianmin Zhang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, China; Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, China.
| |
Collapse
|
20
|
Braun U, Malbon A, Kochan M, Riond B, Janett F, Iten C, Dennler M. Computed tomographic findings and treatment of a bull with pituitary gland abscess. Acta Vet Scand 2017; 59:8. [PMID: 28086988 PMCID: PMC5237170 DOI: 10.1186/s13028-017-0276-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In cattle, the prognosis of brain abscess is unfavourable and treatment is therefore not recommended. To the knowledge of the authors, there has been no report of successful treatment of a brain abscess in cattle.This report describes the clinical, computed tomographic and postmortem findings in a Holstein-Friesian bull with a hypophyseal abscess. CASE REPORT The main clinical findings were generalised ataxia, ptyalism, prolapse of the tongue, dropped jaw, dysphagia, head tilt and unilateral ptosis. Cerebrospinal fluid evaluation revealed 2437 leukocytes/µl and severe pleocytosis. CT examination of the head showed a cavitary lesion consistent with an abscess in the hypophysis. Treatment consisted of gentamicin and flunixin meglumine for 3 days and amoxicillin for 40 days. The neurological signs resolved within 8 days of the start of treatment. The bull was slaughtered 11 months later because of infertility, and a postmortem examination was carried out. Histologically, a mild chronic non suppurative meningoencephalitis restricted to the ventral diencephalon was diagnosed. In addition, there was mild to moderate multifocal chronic lymphoplasmacytic hypophysitis with mild multifocal fibrosis. CONCLUSIONS This case report stresses the significance of CT in confirming the clinical and laboratory diagnosis of central nervous system disorders in cattle and for localising brain lesions. Treatment of the brain abscess resulted, with respect to the central nervous disorder, in a successful outcome and was encouraging considering that most cases have an unfavourable prognosis.
Collapse
|
21
|
Liu Y, Liu F, Liang Q, Li Y, Wang Z. Pituitary abscess: report of two cases and review of the literature. Neuropsychiatr Dis Treat 2017; 13:1521-1526. [PMID: 28652753 PMCID: PMC5476711 DOI: 10.2147/ndt.s138134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pituitary abscess is a rare but critical disorder caused by an infectious process where purulent material accumulates inside the sella turcica. Since symptoms, signs and radiographic characteristics of pituitary abscess are similar to several other pituitary lesions, correct diagnosis before surgery is challenging. In this article, two cases of pituitary abscess treated in our department are reported, followed by a literature review. In these two cases, both patients presented with intermittent fever. Magnetic resonance imaging revealed a suprasellar lesion with rim enhancement after contrast injection. After transsphenoidal surgery, the diagnosis of pituitary abscess was confirmed. The patients were then given antibiotic treatment and recovered fully in less than 2 months. Findings of this article support timely diagnosis and proper treatment including transsphenoidal surgery and antibiotic therapy for pituitary abscess, leading to lower mortality rates and higher probability of pituitary hormone function recovery.
Collapse
Affiliation(s)
- Yu Liu
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha
| | - Feng Liu
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha
| | - Qi Liang
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha
| | - Yexin Li
- Department of Neurosurgery, The Central Hospital of Shaoyang, Shaoyang
| | - Zhifei Wang
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| |
Collapse
|
22
|
Pituitary Abscess Mimicking a Pituitary Adenoma Presenting with Secondary Amenorrhea and Blurring of Vision: A Case Report. J ASEAN Fed Endocr Soc 2017; 32:166-168. [PMID: 33442101 PMCID: PMC7784203 DOI: 10.15605/jafes.032.02.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 12/06/2016] [Indexed: 11/17/2022] Open
Abstract
Pituitary abscess is a rare condition. It can present with hormonal deficiencies and may affect reproductive health. We present a case of a 43-year-old female presenting with bitemporal hemianopsia and amenorrhea. Imaging of the pituitary showed a sellar-suprasellar mass 2.6 x 2.4 x 1.8 cm with an enhancing nodular component. Pre-operative diagnosis was pituitary adenoma with panhypopituitarism and compression of the optic chiasm. The patient underwent transsphenoidal excision of the tumor. Intraoperative findings revealed purulent fluid consistent with pituitary abscess. There was immediate improvement of vision post operatively. She did not develop diabetes insipidus. Gram stain showed polymorphonuclear (PMN) cells 0-1 per oil immersion field (OIF) and Gram-positive cocci 0-1 per OFI, however there was no growth on culture. The abscess was also negative for acid-fast bacilli and was negative on polymerase chain reaction. Histopathologic evaluation showed benign cyst contents. The patient was treated with ceftriaxone 2 grams every 12 hours for 14 days and was eventually discharged with prednisone and levothyroxine. Pituitary abscess is an important differential diagnosis for sellar and suprasellar masses. There are no specific clinical and radiologic features that will enable a preoperative diagnosis of pituitary abscess.
Collapse
|
23
|
Takasuna H, Sasaki R, Shiraishi M, Doi M, Wakui D, Ito H, Oshio K, Tanaka Y. Steroid-resistant Tolosa-Hunt syndrome with a de novo intracavernous aneurysm: A case report. Surg Neurol Int 2016; 7:S779-S784. [PMID: 27920936 PMCID: PMC5122815 DOI: 10.4103/2152-7806.193925] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/10/2016] [Indexed: 11/25/2022] Open
Abstract
Background: We report a case of steroid-resistant Tolosa–Hunt syndrome (THS) with recurrent bilateral painful ophthalmoplegia, accompanied with sphenoid sinusitis, pituitary abscess, and an aneurysm arising from the cavernous portion of the internal carotid artery. Case Description: A 53-year-old woman suffered severe left painful ophthalmoplegia. A magnetic resonance image (MRI) revealed thickness of the left cavernous sinus (CS). Steroid was administrated under the diagnosis of THS, and the symptom transiently diminished. However, painful ophthalmoplegia fluctuated bilaterally after tapering the steroid. An MRI showed development of bilateral cavernous lesions associated with sphenoid sinusitis, pituitary abscess, and an aneurysm in the left C4 segment. Biopsy and drainage of the lesions were performed with an endoscopic transsphenoidal procedure. The histological examination showed nonspecific granulomatous inflammation. The methotrexate (MTX) was effective to reduce the CS and pituitary lesions; however, the aneurysm slightly increased and remained unchanged in size thereafter. Conclusions: To our knowledge, this is the first report of a growing de novo C4 aneurysm in THS. Surgical intervention and administration of MTX should be attempted in steroid-resistant THS. Careful observation with serial MRI and MR angiography is important to manage the complicated THS.
Collapse
Affiliation(s)
- Hiroshi Takasuna
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Rie Sasaki
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Makoto Shiraishi
- Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masatomo Doi
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Daisuke Wakui
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hidemichi Ito
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kotaro Oshio
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuichiro Tanaka
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan
| |
Collapse
|
24
|
Karagiannis AKA, Dimitropoulou F, Papatheodorou A, Lyra S, Seretis A, Vryonidou A. Pituitary abscess: a case report and review of the literature. Endocrinol Diabetes Metab Case Rep 2016; 2016:160014. [PMID: 27274845 PMCID: PMC4890076 DOI: 10.1530/edm-16-0014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 05/04/2016] [Indexed: 11/08/2022] Open
Abstract
UNLABELLED Pituitary abscess is a rare life-threating entity that is usually misdiagnosed as a pituitary tumor with a definite diagnosis only made postoperatively. Over the last several decades, advances in healthcare have led to a significant decrease in morbidity and mortality due to pituitary abscess. We report a case of a 34-year-old woman who was admitted to our department for investigation of a pituitary mass and with symptoms of pituitary dysfunction, headaches and impaired vision. During her admission, she developed meningitis-like symptoms and was treated with antibiotics. She eventually underwent transsphenoidal surgery for excision of the pituitary mass. A significant amount of pus was evident intraoperatively; however, no pathogen was isolated. Six months later, the patient was well and had full recovery of the anterior pituitary function. Her menses returned, and she was only on treatment with desmopressin for diabetes insipidus that developed postoperatively. LEARNING POINTS Pituitary abscess is a rare disease and the reported clinical features vary mimicking other pituitary lesions.The diagnosis of pituitary abscess is often very difficult to make and rarely included in the differential.The histological findings of acute inflammatory infiltration confirm the diagnosis of pituitary abscess.Medical and surgical treatment is usually recommended upon diagnosis of a pituitary abscess.
Collapse
Affiliation(s)
- Apostolos K A Karagiannis
- Department of Endocrinology, Diabetes and Metabolism, Korgialeneio Benakeio EES, Peripheral General Hospital Athens, Athens, Greece
| | - Fotini Dimitropoulou
- Department of Endocrinology, Diabetes and Metabolism, Korgialeneio Benakeio EES, Peripheral General Hospital Athens, Athens, Greece
| | - Athanasios Papatheodorou
- Department of Radiology, Korgialeneio Benakeio EES, Peripheral General Hospital Athens, Athens, Greece
| | - Stavroula Lyra
- Department of Radiology, Korgialeneio Benakeio EES, Peripheral General Hospital Athens, Athens, Greece
| | - Andreas Seretis
- Department of Neurosurgery, General Hospital of Athens ‘G. Gennimatas’, Athens, Greece
| | - Andromachi Vryonidou
- Department of Endocrinology, Diabetes and Metabolism, Korgialeneio Benakeio EES, Peripheral General Hospital Athens, Athens, Greece
| |
Collapse
|
25
|
Pekic S, Popovic V. Alternative causes of hypopituitarism: traumatic brain injury, cranial irradiation, and infections. HANDBOOK OF CLINICAL NEUROLOGY 2014; 124:271-90. [PMID: 25248593 DOI: 10.1016/b978-0-444-59602-4.00018-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Hypopituitarism often remains unrecognized due to subtle clinical manifestations. Anterior pituitary hormone deficiencies may present as isolated or multiple and may be transient or permanent. Traumatic brain injury (TBI) is recognized as a risk factor for hypopituitarism, most frequently presenting with isolated growth hormone deficiency (GHD). Data analysis shows that about 15% of patients with TBI have some degree of hypopituitarism which if not recognized may be mistakenly ascribed to persistent neurologic injury and cognitive impairment. Identification of predictors for hypopituitarism after TBI is important, one of them being the severity of TBI. The mechanisms involve lesions in the hypothalamic-pituitary axis and inflammatory changes in the central nervous system (CNS). With time, hypopituitarism after TBI may progress or reverse. Cranial irradiation is another important risk factor for hypopituitarism. Deficiencies in anterior pituitary hormone secretion (partial or complete) occur following radiation damage to the hypothalamic-pituitary region, the severity and frequency of which correlate with the total radiation dose delivered to the region and the length of follow-up. These radiation-induced hormone deficiencies are irreversible and progressive. Despite numerous case reports, the incidence of hypothalamic-pituitary dysfunction following infectious diseases of the CNS has been underestimated. Hypopituitarism usually relates to the severity of the disease, type of causative agent (bacterial, TBC, fungal, or viral) and primary localization of the infection. Unrecognized hypopituitarism may be misdiagnosed as postencephalitic syndrome, while the presence of a sellar mass with suprasellar extension may be misdiagnosed as pituitary macroadenoma in a patient with pituitary abscess which is potentially a life-threatening disease.
Collapse
Affiliation(s)
- Sandra Pekic
- Faculty of Medicine, University of Belgrade, and Clinic of Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center Belgrade, Belgrade, Serbia
| | - Vera Popovic
- Faculty of Medicine, University of Belgrade, and Clinic of Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center Belgrade, Belgrade, Serbia.
| |
Collapse
|
26
|
Awad AJ, Rowland NC, Mian M, Hiniker A, Tate M, Aghi MK. Etiology, prognosis, and management of secondary pituitary abscesses forming in underlying pituitary adenomas. J Neurooncol 2013; 117:469-76. [PMID: 24185442 DOI: 10.1007/s11060-013-1285-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/21/2013] [Indexed: 11/25/2022]
Abstract
Pituitary abscesses occurring in pre-existing pituitary pathology like Rathke's cleft cyst or adenomas (secondary pituitary abscesses) are rare and of unclear etiology. While surgery and antibiotics have been effective in some cases reported to date, leading to the suggestion that secondary pituitary abscesses are mostly indolent, we investigated the hypothesis that infected adenomas, given their propensity to invade the paranasal sinuses and subarachnoid space, could carry a worse prognosis than uninfected adenomas or secondary abscesses forming in other pituitary pathologies. We identified infected adenomas from our center through retrospective review. Given the rarity of this diagnosis at any single center, we also reviewed published cases of secondary pituitary abscesses occurring in pituitary adenomas to look for common features. Twenty-three cases (19 from the literature and four from our center) of infected adenomas were identified. The mean age at presentation was 46 years, with 65 % male. The most common presenting symptoms were visual disturbances (83 %) and headache (65 %), followed by infectious signs like fever (39 %) and meningitis (26 %). The sphenoidal sinus was the most common site of extrasellar invasion. While good outcome occurred in 74 % of patients, and most achieved vision improvement, the mortality was 26 %. Patients with infected pituitary adenomas commonly present with visual disturbances and headache, with symptoms of infection also occurring. Surgery and antibiotics are indicated for these lesions. While the infection is more indolent than other intracranial abscesses, it is associated with high mortality even after prompt operation and antibiotic treatment.
Collapse
Affiliation(s)
- Ahmed J Awad
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | | | | | | | | | | |
Collapse
|
27
|
El Asri AC, Baallal H, Dao I, Boucetta M. Rare cause of pituitary insufficiency: chronic hypophyseal abscess. Headache 2012; 53:1155-6. [PMID: 23078539 DOI: 10.1111/j.1526-4610.2012.02281.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
28
|
Kohler S, Tschopp O, Bernays RL, Schmid C. An unusual cure for acromegaly. BMJ Case Rep 2012; 2012:bcr.02.2012.5833. [PMID: 22962372 DOI: 10.1136/bcr.02.2012.5833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors present the case of a 30-year-old female patient with acromegaly whose disease had not been cured after transcranial neurosurgery, two transsphenoidal surgeries and stereotactic radiosurgery. She required treatment with octreotide and pegvisomant to normalise growth hormone levels. Seven years after the diagnosis of acromegaly, she noticed acute vision loss in her left eye and presented with meningism. She had an intrasellar abscess which was confirmed and treated by surgical drainage. As a result of the abscess, she was cured of acromegaly and able to discontinue both octreotide and pegvisomant.
Collapse
Affiliation(s)
- Sibylle Kohler
- Endocrinology Department, University Hospital Zurich, Zurich, Switzerland.
| | | | | | | |
Collapse
|
29
|
Gonzales M, Marik PE, Khardori RK, O'Brian JT. A pituitary abscess masquerading as recurrent hypernatremia and aseptic meningitis. BMJ Case Rep 2012; 2012:bcr-2012-006436. [PMID: 22751424 DOI: 10.1136/bcr-2012-006436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pituitary abscess is a rare condition. In the setting of multiple surgical interventions, the risk of its development increases. A 49-year-old man presented with episodes of altered mental status. He had two surgeries for a recurrent suprasellar arachnoid cyst. The second surgery was complicated by a persistent cerebrospinal fluid (CSF) leak that required two repairs following which he developed panhypopituitarism and central diabetes insipidus. Twelve months after his last surgery he was diagnosed with aseptic meningitis. This was followed by recurrent hospitalisations for severe hypernatremia blamed on poor medication compliance. He was subsequently hospitalised for the evaluation of a febrile illness. Brain MRI showed ventriculitis and enhancement of the sella. Exploratory surgery revealed a purulent collection in the sella and a mucosal graft which had been used to repair the CSF leak. After drainage of pus and replacement of the graft he recovered completely but requiring life-long hormonal replacement.
Collapse
Affiliation(s)
- Michael Gonzales
- Department of Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | | | | | | |
Collapse
|
30
|
Diagnosis and minimally invasive surgery for the pituitary abscess: a review of twenty nine cases. Clin Neurol Neurosurg 2012; 114:957-61. [PMID: 22402201 DOI: 10.1016/j.clineuro.2012.02.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 12/24/2011] [Accepted: 02/12/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to better determine the salient signs and symptoms for diagnosis of a pituitary abscess as well as the determination of the most appropriate treatment. METHODS A retrospective analysis was performed using clinical presentations, imaging features, diagnosis and treatment of 29 patients with pituitary abscess in our hospital. RESULTS We made the correct diagnosis of pituitary abscess before surgery only in 2 cases (13.3%) out of 15 patients between January 2004 and January 2008. While 12 cases (85.7%) out of 14 patients were correctly diagnosed before surgery between January 2008 and June 2010. All of the patients underwent transnasal-transsphenoidal surgery assisted by the microscope or endoscope. The antibiotic therapy and hormonal replacement were routinely administrated. The postoperative courses were uneventful and all symptoms of the patients were gradually improved one week to six months after surgery. None of the 29 cases were recurrent during the follow-up. CONCLUSION With the increased clinical experience, the correct diagnosis rate of pituitary abscess before surgery has been greatly improved in recent three years. The microsurgical drainage, proper antibiotics and hormonal replacement are the keys to the treatment of pituitary abscess.
Collapse
|
31
|
Kuge A, Sato S, Takemura S, Sakurada K, Kondo R, Kayama T. Abscess formation associated with pituitary adenoma: A case report: Changes in the MRI appearance of pituitary adenoma before and after abscess formation. Surg Neurol Int 2011; 2:3. [PMID: 21297925 PMCID: PMC3031050 DOI: 10.4103/2152-7806.76140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 09/28/2010] [Indexed: 11/15/2022] Open
Abstract
Background: Pituitary abscess is an extremely rare finding. The abscess may arise as a primary pituitary lesion or be associated with parasellar pathology. It is important for pituitary abscess treatments to perform early diagnosis. In this report, we describe a case of pituitary adenoma in which MRI findings changed during the follow-up period and strongly suggested progression to pituitary abscess arising from adenoma. Case Description: In a 73-year-old female, pituitary adenoma had been incidentally detected; MRI showed typical findings of pituitary adenoma, and we had followed up the pituitary lesion and clinical symptoms. Six months later, she had oculomotor nerve palsy and symptoms of hypopituitarism. Hematological examination revealed inflammation and hypopituitarism. MRI showed striking changes in the signal intensity of the pituitary lesion, and strongly suggested occurrence of sinusitis and pituitary abscess ascribed to pituitary adenoma. She was admitted and endoscopic transsphenoidal surgery was performed. The sellar floor was destroyed, and yellowish-white creamy pus was observed. A histopathological study using hematoxylin-eosin staining showed adenoma and inflammatory cells. Aerobic, anaerobic, and fungal cultures were negative. Antibiotics were administered and hormonal replacement was started. Neurological and general symptoms were improved, and postoperative MRI revealed complete evacuation of abscess and removal of tumor. Conclusions: Pituitary abscess within invasive pituitary adenoma is a rare entity, and shows high mortality. Early diagnosis of pituitary abscess is very important for the prompt surgery and initiation of treatment with antibiotics. In our case, changes in MRI findings were helpful to diagnose pituitary abscess, and endoscopic transsphenoidal surgery was an optimal surgical treatment.
Collapse
Affiliation(s)
- Atsushi Kuge
- Department of Neurosurgery, Yamagata University Faculty of Medicine, 2-2-2 Iidanishi, Yamagata City, Japan
| | | | | | | | | | | |
Collapse
|
32
|
Lin MI, Janss AJ, Wrubel D, Meacham LR. Seventeen-year-old adolescent with pituitary abscess. J Pediatr Endocrinol Metab 2011; 24:771-3. [PMID: 22145473 DOI: 10.1515/jpem.2011.344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pituitary abscess is a rare but potentially life-threatening infectious process. Diagnosis is challenging as symptoms are non-specific and signs of infection may be absent. We report the case of a previously healthy 17-year-old male who presented with worsening headaches, polyuria, polydipsia and no clinical signs of infection. On evaluation, he was found to have hypopituitarism with diabetes insipidus, hypothyroidism and adrenal insufficiency. An imaging study revealed a pituitary mass. He underwent transsphenoidal biopsy to rule out tumor. The abscess was drained transsphenoidally and he was treated with parental antibiotics. Magnetic resonance imaging one year later revealed a normal pituitary without any evidence of abscess or mass. He continues to require thyroid, adrenal and anti-diuretic hormone replacements. As with any pituitary lesion, prompt complete hypothalamic pituitary evaluation is essential to avoid potentially life-threatening consequences.
Collapse
Affiliation(s)
- Michelle I Lin
- Division of Pediatric Endocrinology, Emory Children's Center, 2015 Uppergate Drive, Atlanta, GA 30322, USA.
| | | | | | | |
Collapse
|
33
|
Liu F, Li G, Yao Y, Yang Y, Ma W, Li Y, Chen G, Wang R. Diagnosis and management of pituitary abscess: experiences from 33 cases. Clin Endocrinol (Oxf) 2011; 74:79-88. [PMID: 21039726 DOI: 10.1111/j.1365-2265.2010.03890.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Pituitary abscess is a rare disorder with nonspecific presenting manifestations, often making a correct preoperative diagnosis difficult. To better determine the salient signs and symptoms of pituitary abscess and to evaluate the effectiveness of surgical and antibiotic therapies, we conducted a review of patients treated for pituitary abscess at the Peking Union Medical College Hospital (PUMCH). METHODS A total of 33 consecutive patients referred to PUMCH between 1991 and 2007 were included. While 30 patients underwent surgery and antibiotic therapy, three patients accepted only antibiotic therapy. A complete history, a thorough record of signs and symptoms, pituitary imaging and biochemical panels were obtained for each patient. RESULTS Most of the patients presented with complaints and symptoms consistent with a sellar mass, generally in the absence of any evidence of infection. Diabetes insipidus, hypopituitarism and headache were the most common clinical indicators. Typical magnetic resonance (MR) images after gadolinium injection demonstrated a sellar cystic mass with an enhanced rim. Although there were several recurrences, the abscess resolved in nearly all cases. Hypopituitarism generally did not recover, and hormone replacement therapy was usually necessary. CONCLUSIONS Presentation of diabetes insipidus, hypopituitarism and a sellar cystic mass with an enhanced rim may be suggestive of a pituitary abscess. For most patients, a transsphenoidal evacuation, followed by antibiotic therapy, is recommended. However, antibiotic therapy alone may be useful for acute cases. In our experience, pituitary abscesses can usually be treated, though the accompanying hypopituitarism is difficult to cure, and requiring lifelong hormonal replacement.
Collapse
Affiliation(s)
- Fuyi Liu
- Department of Neurosurgery, Second Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China
| | | | | | | | | | | | | | | |
Collapse
|
34
|
UCHIYAMA T, SAKAI K, ASANUMA M, AOYAMA T, HONGO K. Pituitary Abscess Manifesting as Meningitis and Photophobia Associated With Rathke's Cleft Cyst in a Child -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:455-9. [DOI: 10.2176/nmc.51.455] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Toshiya UCHIYAMA
- Department of Neurosurgery, Shinshu University School of Medicine
| | - Keiichi SAKAI
- Department of Neurosurgery, Shinshu University School of Medicine
| | - Megumi ASANUMA
- Department of Neurosurgery, Shinshu University School of Medicine
| | - Tatsuro AOYAMA
- Department of Neurosurgery, Shinshu University School of Medicine
| | - Kazuhiro HONGO
- Department of Neurosurgery, Shinshu University School of Medicine
| |
Collapse
|
35
|
Bladowska J, Bednarek-Tupikowska G, Sokolska V, Czapiga E, Czapiga B, Sąsiadek M. Unusual presentation of recurrent pituitary abscess. A case report and literature review. Neuroradiol J 2010; 23:600-6. [PMID: 24148681 DOI: 10.1177/197140091002300509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 07/30/2010] [Indexed: 11/16/2022] Open
Abstract
Pituitary abscess is a rare pituitary pathology which may be potentially life-threatening if not treated. Therefore, early accurate diagnosis and therapy are extremely important. However, the clinical diagnosis is difficult because there are no clinical symptoms characteristic of pituitary abscess. It is frequently indistinguishable clinically or with neuroimaging studies from other pituitary lesions. The MR diagnosis of pituitary abscess must be suspected in cases of sellar cystic mass with a peripheral rim enhancement after contrast administration. It must be highlighted that pituitary abscess may show various signal intensity on T1-weighted images, as in our case, making the diagnosis even more difficult. We report an unusual case of a 66-year-old woman who presented with a recurrent pituitary abscess, initially misdiagnosed as a pituitary adenoma because of its high signal intensity on T1-weighted images. The woman was operated on three times, using transsphenoidal access with a good final outcome.
Collapse
Affiliation(s)
- J Bladowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wrocław Medical University; Wrocław, Poland -
| | | | | | | | | | | |
Collapse
|
36
|
Bakker NA, Hoving EW. A rare case of sudden blindness due to a pituitary adenoma coincidentally infected with methicillin-resistant Staphylococcus aureus (MRSA). Acta Neurochir (Wien) 2010; 152:1079-80. [PMID: 19915791 PMCID: PMC2872010 DOI: 10.1007/s00701-009-0551-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 10/19/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Nicolaas A. Bakker
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Eelco W. Hoving
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| |
Collapse
|
37
|
Qi S, Peng J, Pan J, Lu Y, Fan J. Secondary abscess arising in a craniopharyngioma. J Clin Neurosci 2009; 16:1667-9. [PMID: 19766002 DOI: 10.1016/j.jocn.2009.01.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 12/24/2008] [Accepted: 01/04/2009] [Indexed: 11/30/2022]
Abstract
An abscess arising in a craniopharyngioma is rare, but has potentially high mortality and morbidity. Diagnosis is difficult because clinical and neuroradiological characteristics are not clearly defined. We report a patient with a pituitary abscess concomitant with a craniopharyngioma and discuss the pathophysiological mechanism. We discuss the previous five reports and suggest that abscesses with craniopharyngioma remain challenging clinical entities. We speculate that inflammation is a response to components of the ruptured epithelium of the cyst, thereby providing an explanation of the mechanism of abscess formation.
Collapse
Affiliation(s)
- Songtao Qi
- Department of Neurosurgery, Nanfang Hospital of Southern Medical University, Shiliugang Road, Guangzhou, Guangdong 510515, China.
| | | | | | | | | |
Collapse
|