Burak Cabuk1, Melih Caklılı1, Ihsan Anık1, Savas Ceylan1, Ozlem Celik2, Cemal Ustün3. 1. Department of Neurosurgery, Kocaeli University School of Medicine, Pituitary Research Center, Kocaeli, Turkey. 2. Division of Endocrinology and Metabolism, Department of Internal Medicine, Acibadem University School of Medicine, Istanbul, Turkey. 3. Department of Infectious Diseases and Clinical Microbiology, Acibadem University School of Medicine, Istanbul, Turkey.
Abstract
OBJECTIVE: Pituitary abscess is a rare condition, with approximately 300 cases reported in the literature. Primary pituitary abscess, the most common type, occurs in previously healthy normal glands. Secondary pituitary abscess is secondary to pre-existing lesions in the pituitary region, such as pituitary adenoma, Rathke's cleft cysts, or craniopharyngioma and infections. MATERIAL AND METHODS: A total of 2281 patients underwent pituitary surgery via endoscopic transsphenoidal approach in Kocaeli University Pituitary Gland Research Center between 1997 and 2018. Among this cohort 9 patients (4 female and 5 male) were diagnosed with primary pituitary abscess based on both intraoperative findings and postoperative histopathological evidence. RESULTS: Primary pituitary abscess incidence was obtained 0.39% in our center. Mean age of the patients was 50 years old. There was no history of pituitary surgery, radiotherapy and infection diseases in our patients. Visual symptoms were prominent in two patients, hypopituitarism was found in 5 out of the 9 patients. All patients have typical pituitary lesion on pituitary magnetic resonance imaging. Staphylococcus species were the most commonly isolated organisms in the culture. A few weeks of antibiotic therapy were administered after surgery. CONCLUSION: Presentation of fever, headache, diabetes insipidus, hypopituitarism and a sellar cystic mass with an enhanced rim after gadolinium contrast on pituitary magnetic resonance imaging may be suggestive of a pituitary abscess. Transsphenoidal endoscopic surgery, proper antibiotics and appropriate hormone replacement therapy when necessary are the keys of pituitary abscess treatment.
OBJECTIVE:Pituitary abscess is a rare condition, with approximately 300 cases reported in the literature. Primary pituitary abscess, the most common type, occurs in previously healthy normal glands. Secondary pituitary abscess is secondary to pre-existing lesions in the pituitary region, such as pituitary adenoma, Rathke's cleft cysts, or craniopharyngioma and infections. MATERIAL AND METHODS: A total of 2281 patients underwent pituitary surgery via endoscopic transsphenoidal approach in Kocaeli University Pituitary Gland Research Center between 1997 and 2018. Among this cohort 9 patients (4 female and 5 male) were diagnosed with primary pituitary abscess based on both intraoperative findings and postoperative histopathological evidence. RESULTS:Primary pituitary abscess incidence was obtained 0.39% in our center. Mean age of the patients was 50 years old. There was no history of pituitary surgery, radiotherapy and infection diseases in our patients. Visual symptoms were prominent in two patients, hypopituitarism was found in 5 out of the 9 patients. All patients have typical pituitary lesion on pituitary magnetic resonance imaging. Staphylococcus species were the most commonly isolated organisms in the culture. A few weeks of antibiotic therapy were administered after surgery. CONCLUSION: Presentation of fever, headache, diabetes insipidus, hypopituitarism and a sellar cystic mass with an enhanced rim after gadolinium contrast on pituitary magnetic resonance imaging may be suggestive of a pituitary abscess. Transsphenoidal endoscopic surgery, proper antibiotics and appropriate hormone replacement therapy when necessary are the keys of pituitary abscess treatment.
Authors: Agnese Barnabei; Lidia Strigari; Andrea Corsello; Rosa Maria Paragliola; Giovanni Maria Iannantuono; Roberto Salvatori; Salvatore Maria Corsello; Francesco Torino Journal: Front Endocrinol (Lausanne) Date: 2022-03-21 Impact factor: 5.555