Literature ReviewCase Report of a Primary Pituitary Abscess and Systematic Literature Review of Pituitary Abscess with a Focus on Patient Outcomes
Section snippets
Background
Although rare and occurring in 0.2%–1.1% of all operated pituitary lesions,1, 2, 3, 4 pituitary abscess is potentially life threatening and associated with high morbidity and mortality if prompt diagnosis and treatment are not instituted.1, 5, 6 Because of the nonspecific nature of the presentation of the disease, the diagnosis is usually made intraoperatively or postoperatively. One third of all pituitary abscesses are secondary, arising from preexisting lesions such as pituitary adenomas,
Case Description
A 38-year-old woman presented to our medical center after an episode of syncope. She reported left-sided headaches and blurry vision in the left eye for a few months as well as polyuria and polydipsia for 1 month. The patient denied fever, chills, or recent illness. An ophthalmology evaluation showed visual acuity of 20/30 OD and 20/40 OS with a left temporal hemianopic field defect. Preoperative laboratory testing showed increased levels of the following: prolactin (93.5 ng/mL), white blood
Literature Search Strategy and Results
A systematic search of PubMed that included the Medline database was performed using the keywords “pituitary abscess,” “pituitary infection,” “sellar abscess,” “sellar infection,” “suprasellar abscess,” “suprasellar infection,” “hypophyseal abscess,” and “hypophyseal infection” (Figure 2). With filtering for the English language and studies performed on humans, 222 articles were identified. A total of 105 articles were excluded based on their titles bearing no significance to our study. The
Incidence
The differential diagnoses of pituitary lesions are broad and include adenoma, craniopharyngioma, Rathke cleft cyst, epidermoid cyst, carcinoma, and arachnoid cyst. An often overlooked diagnosis that is considered a diagnosis of exclusion is pituitary abscess.
Pituitary abscess is a rare clinical entity, with approximately 200 cases reported in the literature, most of which are case reports. To date, Liu et al.51 have reported the largest series, containing 33 patients. This series represented
Conclusions
Pituitary abscess is a rare disorder and is associated with high morbidity and 4.5% mortality. Patients usually present with headache, visual disturbances, and endocrine abnormalities. The mainstay of treatment is transsphenoidal surgical resection in combination with antibiotic therapy, although a craniotomy approach is warranted in select conditions. Approximately 66.1% of patients achieve partial or complete recovery of pituitary function and 75.7% achieve resolution of visual deficits after
Acknowledgments
We thank Paul H. Dressel, B.F.A., for preparation of the figures and Debra J. Zimmer for editorial assistance.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Present address: Allegheny Health Neuroscience Institute, Department of Neurosurgery, Pittsburgh, Pennsylvania, USA.
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