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Case Reports
. 2024 Apr 25;85(2):e53-e58.
doi: 10.1055/a-2297-3909. eCollection 2024 Apr.

Primary Pituitary Abscess: Two Case Reports

Sayak R Ghosh  1 , Isabella L Pecorari  1 , Abigail Funari  1 , Alexander J Ledet  1 , Anne Lally  1 , Alireza Karandish  1 , Vijay Agarwal  1
Affiliations
Case Reports

Primary Pituitary Abscess: Two Case Reports

Sayak R Ghosh et al. J Neurol Surg Rep. .

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.

Keywords: case reports; hypopituitarism; pituitary abscess; sellar lesions.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Case 1: pre- and post-resection MRI of sella. Preoperative T1-weighted contrast-enhanced MRI in the sagittal plane ( A ) and coronal plane ( B ) demonstrating a large sellar and suprasellar mass with rim enhancement, elevating and compressing the optic chiasm. Postoperative T1-weighted contrast enhanced MRI in the sagittal plane ( C ) and coronal plane ( D ) demonstrating postoperative changes. MRI, magnetic resonance imaging.
Fig. 2
Fig. 2
Case 2: pre- and post-resection MRI of sella. Preoperative T1-weighted contrast-enhanced MRI in the coronal plane ( A ) and sagittal plane ( B ) demonstrating sellar mass encroaching on optic chiasm with hemorrhage within the lesion and peripheral rim enhancement. Postoperative T1-weighted contrast enhanced MRI in the coronal plane ( C ) and sagittal plane ( D ) demonstrating postoperative changes. MRI, magnetic resonance imaging.
Fig. 3
Fig. 3
Algorithm for treatment and follow-up management for pituitary abscess. ACTH, adrenocorticotrophic hormone; CSF, cerebrospinal fluid; DI, diabetes insipidus; T4, thyroxine; TSH, thyroid-stimulating hormone. *Can target antibiotic therapy to culture growth.
See this image and copyright information in PMC

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