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Case Reports
. 2023 Jun 26;18(1):165.
doi: 10.1186/s13023-023-02788-1.

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

Felicity Stringer #  1   2 , Yi Chao Foong #  3   4   5   6 , Alanna Tan  7 , Sarah Hayman  1 , Jeffrey D Zajac  7 , Mathis Grossmann  7 , Justin Ng Yau Zane  8   9   10 , Jasmine Zhu  7 , Sujith Ayyappan  1
Affiliations
Case Reports

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

Felicity Stringer et al. Orphanet J Rare Dis. .

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.

Keywords: Abscess; Hypopituitarism; Pituitary; Rathke’s cleft cyst; Systematic review.

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Conflict of interest statement

The authors declared that they have no competing interests.

Figures

Fig. 1
Fig. 1
Pre-operative MRI brain scan sagittal T1 sequence showing a hypointense pituitary mass
Fig. 2
Fig. 2
Pre-operative MRI brain scan axial T2 sequence showing a hyperintense pituitary mass
Fig. 3
Fig. 3
Post-operative MRI brain scan post-gadolinium T1 sequence showing a pituitary mass with peripheral contrast enhancement
Fig. 4
Fig. 4
Preferred Reporting Items for Systematic Reviews and Meta-analyses diagram illustrating identification of appropriate articles for systematic review of pituitary abscess
See this image and copyright information in PMC

References

    1. 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. - DOI - PubMed
    1. Gao L, et al. Pituitary abscess: clinical manifestations, diagnosis and treatment of 66 cases from a large pituitary center over 23 years. Pituitary. 2017;20(2):189–194. doi: 10.1007/s11102-016-0757-7. - DOI - PubMed
    1. Wang L, et al. Pituitary abscess following transsphenoidal surgery: the experience of 12 cases from a single institution. Clin Neurol Neurosurg. 2014;124:66–71. doi: 10.1016/j.clineuro.2014.06.028. - DOI - PubMed
    1. Liu F, et al. Diagnosis and management of pituitary abscess: experiences from 33 cases. Clin Endocrinol (Oxf) 2011;74(1):79–88. doi: 10.1111/j.1365-2265.2010.03890.x. - DOI - PubMed
    1. Vates GE, Berger MS, Wilson CB. Diagnosis and management of pituitary abscess: a review of twenty-four cases. J Neurosurg. 2001;95(2):233–241. doi: 10.3171/jns.2001.95.2.0233. - DOI - PubMed

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