Elsevier

World Neurosurgery

Volume 101, May 2017, Pages 76-92
World Neurosurgery

Literature Review
Case Report of a Primary Pituitary Abscess and Systematic Literature Review of Pituitary Abscess with a Focus on Patient Outcomes

https://doi.org/10.1016/j.wneu.2017.01.077Get rights and content

Background

Pituitary abscess is a rare but potentially life-threatening condition with an incidence of 0.2%–1.1% of operative pituitary lesions. Diagnosis can be challenging, because this disorder shares many similarities with other pituitary lesions in terms of signs and symptoms and radiographic findings. Most pituitary abscesses are categorized as secondary, arising from preexisting pituitary lesions or in conjunction with transsphenoidal surgery, sepsis, meningitis, or sinusitis. There have been only a few reports of primary pituitary abscess, which occurs without any of the aforementioned risk factors.

Case Description

We present a case of primary pituitary abscess in a 38-year-old woman with headaches, blurry vision, polyuria, and polydipsia who was found to have hypopituitarism. Brain magnetic resonance imaging showed a sellar/suprasellar mass, which was endoscopically resected via a transsphenoidal approach. Egress of yellow-greenish creamy fluid was noted on dural incision. The patient was treated with a 6-week course of antibiotic therapy postoperatively and had resolution of symptoms.

Conclusions

A PubMed search was performed; all cases of pituitary abscess reported in the literature were screened, and 200 cases including our case were analyzed with a focus on outcomes. The most common presentations were headache, visual disturbance, and endocrine abnormalities. Approximately 66.1% of patients achieved partial or complete recovery of pituitary function; 75.7% with vision deficits recovered visual function. Treatment via a craniotomy had a recurrence rate of 17.2% compared with 9.7% via a transsphenoidal approach. To our knowledge, this is the first systematic review on the topic and the largest series reported.

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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