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Furnica RM, Lelotte J, Duprez T, Maiter D, Alexopoulou O. Recurrent pituitary abscess: case report and review of the literature. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM-17-0162. [PMID: 29497537 PMCID: PMC5825836 DOI: 10.1530/edm-17-0162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/02/2018] [Indexed: 12/28/2022] Open
Abstract
A 26-year-old woman presented with severe postpartum headaches. Magnetic resonance imaging (MRI) revealed a symmetric, heterogeneous enlargement of the pituitary gland. Three months later, she developed central diabetes insipidus. A diagnosis of postpartum hypophysitis was suspected and corticosteroids were prescribed. Six months later, the pituitary mass showed further enlargement and characteristics of a necrotic abscess with a peripheral shell and infiltration of the hypothalamus. Transsphenoidal surgery was performed, disclosing a pus-filled cavity which was drained. No bacterial growth was observed, except a single positive blood culture for Staphylococcus aureus, considered at that time as a potential contaminant. A short antibiotic course was, however, administered together with hormonal substitution for panhypopituitarism. Four months after her discharge, severe headaches recurred. Pituitary MRI was suggestive of a persistent inflammatory mass of the sellar region. She underwent a new transsphenoidal resection of a residual abscess. At that time, the sellar aspiration fluid was positive for Staphylococcus aureus and she was treated with antibiotics for 6 weeks, after which she had complete resolution of her infection. The possibility of a pituitary abscess, although rare, should be kept in mind during evaluation for a necrotic inflammatory pituitary mass with severe headaches and hormonal deficiencies.
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Affiliation(s)
- Raluca Maria Furnica
- Departments of Endocrinology, Pathology, and NeuroradiologyUniversité catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Julie Lelotte
- Departments of Pathology, and NeuroradiologyUniversité catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Thierry Duprez
- Departments of NeuroradiologyUniversité catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Dominique Maiter
- Departments of Endocrinology, Pathology, and NeuroradiologyUniversité catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Orsalia Alexopoulou
- Departments of Endocrinology, Pathology, and NeuroradiologyUniversité catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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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.
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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.
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Hazra S, Acharyya S, Acharyya K. Primary pituitary abscess in an adolescent boy: a rare occurrence. BMJ Case Rep 2012; 2012:bcr-2012-007134. [PMID: 23257693 DOI: 10.1136/bcr-2012-007134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary pituitary abscess is a rare clinical condition at a young age. It is characterised by atypical clinical features which makes the diagnosis difficult. Correct diagnosis and therapy are mandatory due to the potentially lethal outcome. We report the case of a 14-year-old healthy boy. The onset was acute with fever, gait imbalance, slurring of speech and amnesia. MRI brain revealed a hyperintense lesion in T2-weighted image (T2WI) in sellar and suprasellar region, which was hypointense in T1WI. After administration of contrast, there was peripheral rim enhancement suggesting pituitary abscess. The diagnosis was confirmed following evacuation of purulent material, during surgery, through a trans-sphenoidal approach. Postoperatively, the boy needed prolonged intensive care support. He was discharged on day 42 after surgery. Follow-up at 3 months revealed complete motor recovery. He required hormone replacement and was intermittently showing features suggestive of frontal lobe syndrome.
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Affiliation(s)
- Samik Hazra
- Department of Paediatrics, Calcutta Medical Research Institute, Kolkata, West Bengal, India
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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.
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Affiliation(s)
- Fuyi Liu
- Department of Neurosurgery, Second Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China
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Shirakawa J, Takeshita T, Miyao M, Orimo S, Terauchi Y, Mizuno Y. Pituitary abscess with panhypopituitarism showing T1 signal hyperintensity of the marginal pituitary area: a non-invasive differential diagnosis of pituitary abscess and pituitary apoplexy. Intern Med 2009; 48:441-6. [PMID: 19293544 DOI: 10.2169/internalmedicine.48.1769] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 53-year-old man was hospitalized with general fatigue, headache, dizziness and polyuria. The laboratory findings revealed anterior hypopituitarism and central diabetes insipidus. He also showed eye movement disorder and facial sensory impairment. These symptoms were treated successfully with conservative medical treatment. Concurrently, abnormal pituitary MR imaging findings were revealed. Pituitary abscess was primarily suspected on MR imaging findings, although it was difficult to differentiate pituitary apoplexy by MR imaging findings, alone. In this report, we propose a new diagnostic approach of pituitary abscess, using a combination of CT, MR imaging and clinical manifestations, without either pituitary surgery or pituitary biopsy.
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Affiliation(s)
- Jun Shirakawa
- Department of Endocrinology and Metabolism, Kanto Central Hospital, Tokyo.
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Ciappetta P, Calace A, D'Urso PI, De Candia N. Endoscopic treatment of pituitary abscess: two case reports and literature review. Neurosurg Rev 2007; 31:237-46; discussion 246. [PMID: 17899232 DOI: 10.1007/s10143-007-0096-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2007] [Revised: 06/12/2007] [Accepted: 08/18/2007] [Indexed: 10/22/2022]
Abstract
Pituitary abscess is a rare entity and the correct diagnosis is still difficult before surgery. More than 210 cases have been reported in the medical literature, mostly in the form of isolated case reports. We report two cases of pituitary abscess treated endoscopically and we review the literature. A 30-year-old woman and a 35-year-old man were admitted with a history of pituitary dysfunction. Patient 1 presented with polyuria, polydipsia, amenorrhea, headache, and visual impairment. Magnetic resonance imaging showed a cystic intra- and supra-sellar lesion with ring enhancement after contrast injection. Patient 2 presented with frontal headache, proptosis, painful ophthalmoplegia, visual impairment, and fever. Eight years before the patient had undergone a transphenoidal surgery for Prolactinoma. Magnetic resonance imaging revealed a sellar lesion extending into the cavernous sinus and carotid artery bilaterally. Both patients underwent endoscopic transnasal-transsphenoidal exploration. Intraoperative diagnosis of pituitary abscess was made. The postoperative courses were uneventful. Antibiotic therapy was performed in both cases. Only three cases of endoscopic treatment of pituitary abscess have been reported in the literature. We recommend early management by endoscopic transphenoidal surgery for pituitary abscess: this technique is safe, with minimal blood loss, short operating time, low morbidity, and brief hospital stay.
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Affiliation(s)
- Pasqualino Ciappetta
- Section of Neurosurgery, Department of Neurological Sciences, University of Bari Medical School, Piazza Giulio Cesare, 11, 70124 Bari, Italy
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