Abstract
Pituitary abscess is a rare entity and the correct diagnosis is still difficult before surgery. More than 210 cases have been reported in the medical literature, mostly in the form of isolated case reports. We report two cases of pituitary abscess treated endoscopically and we review the literature. A 30-year-old woman and a 35-year-old man were admitted with a history of pituitary dysfunction. Patient 1 presented with polyuria, polydipsia, amenorrhea, headache, and visual impairment. Magnetic resonance imaging showed a cystic intra- and supra-sellar lesion with ring enhancement after contrast injection. Patient 2 presented with frontal headache, proptosis, painful ophthalmoplegia, visual impairment, and fever. Eight years before the patient had undergone a transphenoidal surgery for Prolactinoma. Magnetic resonance imaging revealed a sellar lesion extending into the cavernous sinus and carotid artery bilaterally. Both patients underwent endoscopic transnasal-transsphenoidal exploration. Intraoperative diagnosis of pituitary abscess was made. The postoperative courses were uneventful. Antibiotic therapy was performed in both cases. Only three cases of endoscopic treatment of pituitary abscess have been reported in the literature. We recommend early management by endoscopic transphenoidal surgery for pituitary abscess: this technique is safe, with minimal blood loss, short operating time, low morbidity, and brief hospital stay.
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References
Abs R, Parizel PM, Verlooy J, Neetens I, Arnouts P (1993) Magnetic resonance characterization of a long-standing pituitary abscess. J Endocrinol Investig 16:635–637
Arseni C, Danaila L, Carp N, Ghitescu M, Istrati C (1975) Intrasellar abscess. Neurochirurgia (Stuttg) 18:207–213
Asenjo A (1954) Operierter pneumakokken-abzess in einem transitions-hypophysen-adenom [in German]. Acta Neurochir 3:100–103
Askenasy HM, Israeli J, Karny H, Dujovny M (1971) Intrasellar abscess simulating pituitary adenoma. Neurochirurgia 14:34–37
Barrada Y, Guinea Y, Abd El Naby S, Taher Y (1952) Intra-sellar abscess simulating chromophobe adenoma. J Egypt Med Assoc 35:105–112
Bianchi NO, Cabarrou A, Caino HV, Burry C, Baylon N (1961) Abscess of the pituitary gland. Prensa Med Argent 7(48):876–881
Bognar L, Szeifert GT, Fedorcsak I, Pasztor E (1992) Abscess formation in Rathke’s cleft cyst. Acta Neurochir (Wien) 117:70–72
Bossard D, Himed A, Badet C, Lapras V, Mornex R, Fisher G, Tavernier T, Bochu M (1992) MRI and CT in a case of pituitary abscess. J Neuroradiol 19:139–144
Bouche J, Guiot G, Carrez P, Cotin G, Comoy C (1964) Intracranial complications of sphenoid sinusitis: cavernous sindrome; pituitary abscess. Surgical approach by low rhino-septal route (in French). Presse Med 24:1875–1880
Bouche J, Guiot G, Freche C, Cotin G (1964) Abcess of the pituitary. Approach by low transeptal route (in French). Ann Otolaryngol Chir Cervicofac 81:834–838
Buchfelder M, Honegger J, Fahlbusch R, Thierauf P (1989) Rare intrasellar and suprasellar processes. 2 Inflammatory processes. Inflammatory processes of the sella turcica (in German). Nervenarzt 60:679–684
Celikoglu E, Boran BO, Bozbuga M (2006) Abscess formation in Rathke’s cleft cyst. Neurol India 54:213–214, (letter)
De Villiers Hamman H (1956) Abscess formation in the pituitary fossa ssociated with a pituitary adenoma. J Neurosurg 13:208–210
Dechambenoit G, Datie A, Grunitzky EK, Ba Zeze V, Boni N, Kakou M, Santini JJ (1993) Pituitary abscess treated by medication (in French). Rev Neurol (Paris) 149:567–571
Diaz-Aramendi A, Garibi J, Zorrilla J, Aurrechoechea J, Claro T (1993) Pituitary abscess. Neurochirurgie 39:125–127
Dickob M, Scharphuis T, Distelmaier P, Hoffmann G (1989) Diagnosis of hypophyseal abscess using MRI and high resolution CT. Neurochirurgia (Stuttg) 32:184–186
Domingue JN, Wilson CB (1977) Pituitary abscess: report of seven cases and review of literature. J Neurosurg 46:601–608
Donnet A, Trefouret S, Millet Y, Grisoli F (1999) Pituitary abscess revealed by sleep attacks. Surg Neurol 51:564–565
Dutta P, Bhansali A, Singh P, Kotwal N, Pathak A, Kumar Y (2006) Pituitary abscess: report of four cases and review of literature. Pituitary 9:267–273
Ekelund C (1945) Om en akuta hypophysiten och dess relation till Simmond’s Syndrom[in swedish]. Nord Med 28:2640–2642
Erdogan G, Deda H, Tonyukuk V (2001) Magnetic resonance imaging and computerized tomography images in a case of pituitary abscess. J Endocrinol Investig 23:887–891
Feely M, Steinberg M (1977) Aspergillus infection complicating trassphenoidal yttrium-90 pituitary implant. Report of two cases. J Neurosurg 46:530–532
Ford J, Torres LF, Cox T, Hayward R (1986) Recurrent sterile meningitis caused by a pituitary abscess. Postgrad Med J 62:929–931
Franceschetti A, Doret M, Babel J, Werner A (1956) Chiasmatic syndrome: frequency of its non-pituitary origin; need for an early diagnosis with retrobulbular optic neuritis (in French). Praxis 5(45):313–381
Gokalp HZ, Deda H, Baskaya MK, Bulay O, Erekul S (1994) Pituitary abscesses. Report of three cases. Neurosurg Rev 17:199–203
Gomez Perun J, Eiras J, Carcavilla LI (1981) Intrasellar abscess into a cyst of the Rathke’s pouch (author translation). Neurochirurgie 27:201–205
Grosskopf D, Chamouard JM, Bosquet F, Billet R, Poisson M, Buge A (1987) Pituitary abscess. Study of a case and review of the literature (in French). Neurochirurgie 33:228–311
Güven MB, Cirak B, Kutluhan A, Ugras S (1999) Pituitary abscess secondary to neurobrucellosis. J Neurosurg 90:1142
Hanel RA, Koerbel A, Prevedello DM, Moro MS, Araujo JC (2002) Primary pituitary adenoma. Arq Neuro-Psiquiatr 60:861–865
Har-El G, Swanson RM, Kent RH (1996) Unusual presentation of a pituitary abscess. Surg Neurol 45:351–353
Hatiboglu MA, Iplikcioglu AC, Ozcan D (2006) Abscess formation within invasive pituitary adenoma. J Clin Neurosci 13:774–777
Heary RF, Maniker AH, Wolansky LJ (1995) Candidal pituitary abscess: case report. Neurosurgery 36:1009
Henegar MM, Koby MB, Silbergeld DL, Rich KM, Moran CJ (1996) Intrasellar abscess following transsphenoidal surgery. Surg Neurol 45:183–188
Hernandez I, Garcia L, Guinto G, Cabrera L, Mercado M (2002) Bacterial pituitary abscess: an unusual cause of panhypopituitarism. Endocr Pract 8:424–428
Heslop TP (1848) A case of hypertrophy with abscess of the pituitary body. Dublin Quart J M 6:466
Holck S, Laursen H (1983) Prolactinoma coexistent with granulomatous hypophysitis. Acta Neuropathol (Berl) 61:253–257
Hon CS, Knuckey N, Robbins P, Pullan PT (1999) Pituitary abscess. J Clin Neurosci 6(4):351–353
Jadhav RN, Dahiwadkar HV, Palande DA (1998) Abscess formation in invasive pituitary adenoma: case report. Neurosurgery 3:616–622
Jain KC, Varma A, Mahapatra AK (1997) Pituitary abscess: a series of six cases. Br J Neurosurg 11:139–143
Jaiswal AK, Mahapatra AK, Sharma MC (2004) Pituitary abscess associated with prolactinoma. J Clin Neurosci 11:533–534
Kabuto M, Kubota T, Kobayashi H, Takeuchi H, Kubota T, Nakagawa T, Kodera T (1996) MR imaging and CT of pituitary abscess: case report and review. Neurol Res 18:495–498
Kaur A, Agrawal A, Mittal M (2005) Presumed pituitary abscess without infectious source treated successfully with antibiotics alone. J Neuroophthalmol 25:185–188
Kroppenstedt SN, Liebig T, Mueller W, Graf KJ, Lanksch WR, Unterberg AW (2001) Secondary abscess formation in pituitary adenoma after tooth extraction. Case report. J Neurosurg 94:335–338
Larranaga J, Fandino J, Gomez-Bueno J, Rodriguez D, Gonzalez-Carrero J, Botana C (1989) Aspergillosis of the sphenoid sinus simulating a pituitary tumor. Neuroradiology 31:362–363
Leff RS, Martino RL, Pollock WJ, Knight WA (1989) Pituitary abscess after autologous bone marrow transplantation. Am J Hematol 31:62–64
Leramo OB, Char G (1989) Intrasellar abscess simulating a pituitary tumour. West Indian Med J 38:171–175
Lindholm J, Rasmussen P, Korsgaard O (1973) Intrasellar or pituitary abscess. J Neurosurg 38:616–619
Marks PV, Furneaux CE (1984) Pituitary abscess following asymptomatic sphenoid sinusitis. J Laryngol Otol 98:1151–1155
Martines F, Scarano P, Chiappetta F, Gigli R (1996) Pituitary abscess: a case report and review of the literature. J Neurosurg Sci 40:135–138
Matsuno A, Ogino Y, Katayama H, Nagashima T (2005) Pituitary abscess in a patient with painless thyroiditis. J Clin Neurosci 12:190–193
Medoc J, Purriel JA, Leiserson R (1966) Abscess of the pituitary gland and purulent meningitis. Acta Neurol Latinoam 12:71–75
Montrieul B, Janny P, Pignide L, Chabannes J (1965) Observations on hypophyseal abscesses (in French). Neurochirurgie 11:366–371
Neelon FA, Mahaley MS (1976) Chiasmal syndrome due to intrasellar abscess. Arch Intern Med 136:1041–1043
Nelson PB, Haverkos H, Martinez AJ, Robinson AG (1983) Abscess formation within pituitary tumors. Neurosurgery 12:331–333
Nishimura K, Takao T, Mimoto T, Matsumori A, Sasaoka A, Hashimoto K (2003) A case of anterior hypopituitarism showing recurrent pituitary mass associated with central diabetes insipidus. Endocr J 50:825–829
Obenchain TG, Becker DP (1972) Abscess formation in a Rathke’s cleft cyst. Case report. J Neurosurg 36:359–362
Obrador S, Blazquez MG (1972) Pituitary abscess in a craniopharyngioma. J Neuorsurg 36:785–789
Ramos-Gabatin A, Jordan RM (1981) Primary pituitary aspergillosis responding to transsphenoidal surgery and combined therapy with amphotericin-B and 5-fluorocytosine: case report. J Neurosurg 54:839–841
Reddy K, Fewer D, West M (1991) Complications of the transsphenoidal approach to sellar lesions. Can J Neurol Sci 18:463–466
Riser M, Lazorthes G, Anduze-Acher H (1956) Les abcès de l’hypophyse (in French). Rev Oto-neuro-ophthal 28:494–496
Robinson B (1983) Intrasellar abscess after transsphenoidal pituitary adenomectomy. Neurosurgery 12:684–686
Rongetti JR, Daniels JT (1950) Treatment of empyema of the sella turcica of sphenoid origin. Arch Otolaryngol 52:166–171
Sabbah P, Bonardel G, Herve R, Marjou F, Hor F, Pharaboz C, Bauduceau B (1999) CT and MRI findings in primitive pituitary abscess: a case report and review of literature. J Neuroradiol 26:196–199
Sahjpaul RL, Lee DH (1999) Infratentorial subdural empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis secondary to paranasal sinusitis: case report. Neurosurgery 44:864–868
Scanarini M, Rotilio A, Rigobello L, Pomes A, Parenti A, Alessio L (1991) Primary intrasellar coccidioidomycosis simulating a pituitary adenoma. Neurosurgery 28:748–751
Schwartz ID, Zalles MC, Foster JL, Burry VF (1995) Pituitary abscess: an unusual presentation of “aseptic meningitis”. J Pediatr Endocrinol Metab 8:141–146
Selosse P, Mahler C, Klaes RL (1980) Pituitary abscess. Case report. J Neurosurg 53:851–852
Shanley DJ, Holmes SM (1994) Salmonella typhi abscess in a craniopharyngioma: CT and MRI. Neuroradiology 36:35–36
Shono T, Nishio S, Muratani H, Yasuda T, Fukui M, Moutai K (1999) Pituitary abscess secondary to isolated sphenoid sinusitis. Minim Invasive Neurosurg 42:204–206
Simmonds M (1914) Zur Pathologie der Ag hypophysis (in German). Verh Dtsch Pathol 17:208–212
Somali MH, Anastasiou AL, Goulis DG, Polyzoides C, Avramides A (2001) Pituitary abscess presenting with cranial nerve paresis. Case report and review of literature. J Endocrinol Investig 24:45–50
Svein HJ, Love JG (1942) Abscess within the sella turcica simulating pituitary tumor: surgical cure. Mayo Clin Proc 17:497–501
Takao H, Doi I, Watanabe T (2006) Diffusion-weighted magnetic resonance imaging in pituitary abscess. J Comput Assist Tomogr 30:514–516
Takayasu T, Yamasaki F, Tominaga A, Hidaka T, Arita K, Kurisu K (2006) A pituitary abscess showing high signal intensity on diffusion-weighted imaging. Neurosurg Rev 29:246–248
Thomas N, Wittert GA, Scott G, Reilly PL (1998) Infection of a Rathke’s cleft cyst: a rare cause of pituitary abscess. Case illustration. J Neurosurg 89:682
Uede T, Daibo M, Ohotaki M, Morimoto S, Tanabe S, Hashi K (1986) Pituitary abscess: report of two cases and a review [in Japanese]. No Shinkei Geka 14:1383–1388
Utsuki S, Oka H, Tanaka S, Iwamoto K, Hasegawa H, Hirose R, Fujii K (2005) Blurred vision caused by inflammation of the optic nerves due to a pituitary abscess. Neurol Med Chir (Tokyo) 45:327–330
Vates GE, Berger MS, Wilson CB (2001) Diagnosis and management of pituitary abscess: a review of twenty-four cases. J Neurosurg 95:233–241
Whalley N (1952) Abscess formation in a pituitary adenoma. J Neurol Neurosurg Psychiatry 15:66–67
Wolansky LJ, Gallagher JD, Heary RF, Malantic GP, Dasmahapatra A, Shaderowfsky PD, Budhwani N (1997) MRI of the pituitary abscess: two cases and review of the literature. Neuroradiology 39:499–503
Zorub DS, Martinez AJ, Nelson PB, Lam MT (1979) Invasive pituitary adenoma with abscess formation: case report. Neurosurgery 5:718–722
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We are grateful to Mrs. Chrissie Oppedisano for the English revision.
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Alessandro Ducati, Torino, Italy
This is a complete review of a rare but not exceptional lesion, namely, pituitary abscess. The Authors report their experience concerning two new cases, and comment on the other 300 pituitary abscess reported in the Literature. The main contribution of this paper, is, on my opinion, the efficacy of treatment provided by an endoscopic endonasal approach, which minimizes the local surgical trauma. As in cerebral surgery, also in this case, the evacuation of pus and necrotic material with just a puncture is the best and safer treatment. More aggressive approaches may cause diffusion of the infection to the meninges and to the brain, with possible devastating effects. Considering the difficulties to obtain a preoperative diagnosis of pituitary abscess (even though in case 2 it should be suspected), this is a further argument in favor of endoscopic endonasal approach to pituitary masses.
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Ciappetta, P., Calace, A., D’Urso, P.I. et al. Endoscopic treatment of pituitary abscess: two case reports and literature review. Neurosurg Rev 31, 237–246 (2008). https://doi.org/10.1007/s10143-007-0096-2
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DOI: https://doi.org/10.1007/s10143-007-0096-2