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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.
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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
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Kawano T, Shinojima N, Hanatani S, Araki E, Mikami Y, Mukasa A. Atypical pituitary abscess lacking rim enhancement and diffusion restriction with an unusual organism, Moraxella catarrhalis: A case report and review of the literature. Surg Neurol Int 2021; 12:617. [PMID: 34992933 PMCID: PMC8720480 DOI: 10.25259/sni_835_2021] [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: 08/19/2021] [Accepted: 11/30/2021] [Indexed: 11/04/2022] Open
Abstract
Background:
Pituitary abscess (PA) can be fatal if diagnosed late. Rim enhancement is a typical radiological finding of PA on postgadolinium T1-weighted magnetic resonance imaging (MRI). Diffusion-weighted imaging is helpful in distinguishing PA from other sellar cystic lesions. Herein, we report the first atypical case of PA showing neither rim enhancement nor diffusion restriction with an unusual organism, Moraxella catarrhalis.
Case Description:
A 77-year-old woman presented with headache, polyuria, polydipsia, and fatigue for a month before presenting to a local hospital. MRI showed pituitary enlargement with contrast enhancement. She had neither fever nor visual deficits and was followed up with hormonal replacement. Six months later, she complained of visual impairment, and MRI showed further pituitary enlargement with a thickened stalk compressing the optic chiasma. Neither rim enhancement nor diffusion restriction was observed. Endoscopic endonasal transsphenoidal surgery was performed based on the radiological diagnosis of lymphocytic hypophysitis or pituitary tumors. A thick, creamy yellow pus was drained from the sellar lesion. Intraoperative rapid histopathological findings revealed polymorphonuclear leukocytes infiltrating the pituitary gland. PA was diagnosed, and irrigation and open drainage of the abscess was performed. Bacterial culture of the pus detected M. catarrhalis by mass spectrometer, confirming the diagnosis. She underwent appropriate antibiotic administration, and her visual deficits improved.
Conclusion:
We report the first atypical case of PA showing neither rim enhancement nor diffusion restriction with M. catarrhalis. Even if preoperative findings are not suggestive of PA, it should be considered as a differential diagnosis. Intraoperative rapid histopathological findings are useful for accurately diagnosing PA and initiating appropriate surgical treatment.
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Affiliation(s)
- Tatsuya Kawano
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Naoki Shinojima
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Satoko Hanatani
- Department of Metabolic Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Eiichi Araki
- Department of Metabolic Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
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Mintz JL, Jameson MB, Akinseye L, Los EA. Pediatric diabetic ketoacidosis presenting with Streptococcus intermedius brain abscess. J Pediatr Endocrinol Metab 2021; 34:817-820. [PMID: 33851524 DOI: 10.1515/jpem-2020-0711] [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: 12/14/2020] [Accepted: 01/18/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Report a novel case of new-onset type 1 diabetes in a pediatric patient presenting with DKA and concurrent Streptococcus intermedius brain abscess. CASE PRESENTATION The following case report is that of a previously healthy 12 year-old girl presenting with new-onset type 1 diabetes with mild diabetic ketoacidosis and subsequently found to have a brain abscess. Over the course of her hospital stay, she developed seizures and was found to have a 1.3 × 1.0 × 1.2 cm right frontal parasagittal mass culture-positive for S. intermedius. Neurologic symptoms were unmasked once insulin treatment was initiated and ketosis improved, supporting the relationship between therapeutic ketosis and the management of medication-refractory epilepsy. CONCLUSIONS This case both supports the relationship between therapeutic ketosis and the management of medication-refractory epilepsy and highlights the need to carefully consider comorbid conditions in patients with DKA and new onset neurological symptoms.
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Affiliation(s)
- Judy L Mintz
- East Tennessee State University James H Quillen College of Medicine, Johnson City, Tennessee, USA
| | - Morghan B Jameson
- East Tennessee State University James H Quillen College of Medicine, Johnson City, Tennessee, USA
| | - Leah Akinseye
- Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Evan A Los
- Pediatric Endocrinology, East Tennessee State University James H Quillen College of Medicine, Johnson City, Tennessee, USA
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Zheng K, Fei H, Bai Z, Hao L, Liu Y, Shi Y. Pituitary abscess misdiagnosed as pituitary adenoma stroke: Case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Radhouane K, Bedioui A, Yedeas MD, Zayet S, Jebari M, Yedeas M, Harbaoui A, Chkili R. Brain abscess due to Candida glabrata in an immunocompetent patient. A case report with update and literature review. IDCases 2020; 22:e00996. [PMID: 33204632 PMCID: PMC7652781 DOI: 10.1016/j.idcr.2020.e00996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 11/28/2022] Open
Abstract
Candida spp. brain abscess is scare. Clinical presentation is unspecific. Diagnosis requires mycological culture of a puncture or biopsy specimen. Therapeutic management is based on prolonged course of azole or liposomal amphotericin B. We reported the case of Candida glabrata brain abscess in a 27 year-old female patient, with no past history and not secondary to candidemia. The fungus was isolated from a puncture of abscess with complete resection. The outcome was favorable under antifungal treatment by voriconazole.
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Affiliation(s)
- Khaled Radhouane
- Department of Neurosurgery, Military Hospital of Tunis, Université de Tunis El Manar, Tunisia
- Corresponding author at: 23, Rue du Lac Constance, Les Berges du Lac, Tunis 1053, Tunisia.
| | - Aziz Bedioui
- Department of Neurosurgery, Military Hospital of Tunis, Université de Tunis El Manar, Tunisia
| | - Mohamed Dehmani Yedeas
- Department of Neurosurgery, Military Hospital of Tunis, Université de Tunis El Manar, Tunisia
| | - Souheil Zayet
- Department of Infectious Diseases, University Hospital La Rabta, Université de Tunis El Manar, Tunisia
| | - Maroua Jebari
- Department of Neurosurgery, Military Hospital of Tunis, Université de Tunis El Manar, Tunisia
| | - Mondher Yedeas
- Department of Neurosurgery, Military Hospital of Tunis, Université de Tunis El Manar, Tunisia
| | - Ahmed Harbaoui
- Department of Neurosurgery, Military Hospital of Tunis, Université de Tunis El Manar, Tunisia
| | - Ridha Chkili
- Department of Neurosurgery, Military Hospital of Tunis, Université de Tunis El Manar, Tunisia
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Saffarian A, Derakhshan N, Taghipour M, Eghbal K, Roshanfarzad M, Dehghanian A. Sphenoid Aspergilloma with Headache and Acute Vision Loss. World Neurosurg 2018; 115:159-161. [PMID: 29678700 DOI: 10.1016/j.wneu.2018.04.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/07/2018] [Accepted: 04/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fungal infection is a rare pathology in the sphenoid sinus, and extension into the pituitary fossa with visual loss has only been described in a few reports in the literature. Following publication of a recent report of pituitary abscess by Candida glabrata, we describe our own experience with a similar pathology. CASE DESCRIPTION In the present report, we overview a diabetic patient who sustained aspergilloma in his sphenoid sinus with extension to the pituitary fossa. Clinical presentations are discussed along with an emphasis on the role of endoscopic endonasal drainage of the abscess as the mainstay of treatment. Following administration of intravenous amphotericin B for 6 days, endoscopic drainage of the aspergillus abscess was done. Visual acuity improved immediately after the operation. At the 12-month follow-up visit, the improvement in visual acuity was maintained and magnetic resonance imaging showed no recurrence. CONCLUSION Correction of the underlying immune deficiencies, administration of intravenous antifungal agents perioperatively, endoscopic endonasal drainage of abscess, and a meticulous debridement of necrotic material, followed by a course of oral antifungal medication, comprises the standard treatment protocol for a fungus ball (aspergilloma) of the sphenoid sinus.
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Affiliation(s)
- Arash Saffarian
- Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Derakhshan
- Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mousa Taghipour
- Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keyvan Eghbal
- Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Roshanfarzad
- Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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