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Etiology, prognosis, and management of secondary pituitary abscesses forming in underlying pituitary adenomas

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Abstract

Pituitary abscesses occurring in pre-existing pituitary pathology like Rathke’s cleft cyst or adenomas (secondary pituitary abscesses) are rare and of unclear etiology. While surgery and antibiotics have been effective in some cases reported to date, leading to the suggestion that secondary pituitary abscesses are mostly indolent, we investigated the hypothesis that infected adenomas, given their propensity to invade the paranasal sinuses and subarachnoid space, could carry a worse prognosis than uninfected adenomas or secondary abscesses forming in other pituitary pathologies. We identified infected adenomas from our center through retrospective review. Given the rarity of this diagnosis at any single center, we also reviewed published cases of secondary pituitary abscesses occurring in pituitary adenomas to look for common features. Twenty-three cases (19 from the literature and four from our center) of infected adenomas were identified. The mean age at presentation was 46 years, with 65 % male. The most common presenting symptoms were visual disturbances (83 %) and headache (65 %), followed by infectious signs like fever (39 %) and meningitis (26 %). The sphenoidal sinus was the most common site of extrasellar invasion. While good outcome occurred in 74 % of patients, and most achieved vision improvement, the mortality was 26 %. Patients with infected pituitary adenomas commonly present with visual disturbances and headache, with symptoms of infection also occurring. Surgery and antibiotics are indicated for these lesions. While the infection is more indolent than other intracranial abscesses, it is associated with high mortality even after prompt operation and antibiotic treatment.

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References

  1. Domingue JN, Wilson CB (1977) Pituitary abscesses. Report of seven cases and review of the literature. J Neurosurg 46:601–608. doi:10.3171/jns.1977.46.5.0601

    Article  CAS  PubMed  Google Scholar 

  2. Jain KC, Varma A, Mahapatra AK (1997) Pituitary abscess: a series of six cases. Br J Neurosurg 11:139–143

    Article  CAS  PubMed  Google Scholar 

  3. Tate MC, Jahangiri A, Blevins L, Kunwar S, Aghi MK (2010) Infected Rathke cleft cysts: distinguishing factors and factors predicting recurrence. Neurosurgery 67:762–769. doi:10.1227/01.NEU.0000377017.53294.B5 Discussion 769

    Article  PubMed  Google Scholar 

  4. Vates GE, Berger MS, Wilson CB (2001) Diagnosis and management of pituitary abscess: a review of twenty-four cases. J Neurosurg 95:233–241. doi:10.3171/jns.2001.95.2.0233

    Article  CAS  PubMed  Google Scholar 

  5. Liu F, Li G, Yao Y, Yang Y, Ma W, Li Y, Chen G, Wang R (2011) Diagnosis and management of pituitary abscess: experiences from 33 cases. Clin Endocrinol 74:79–88. doi:10.1111/j.1365-2265.2010.03890.x

    Article  Google Scholar 

  6. Asenjo A (1950) Absceso de neumococos operado en adenoma de transicion de la hipofisis. Arch Soc Ciruj Chile 2:312–314

    Google Scholar 

  7. Whalley N (1952) Abscess formation in a pituitary adenoma. J Neurol Neurosurg Psychiatry 15:66–67

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. De Villiers Hammann H (1956) Abscess formation in the pituitary fossa associated with a pituitary adenoma. J Neurosurg 13:208–210. doi:10.3171/jns.1956.13.2.0208

    Article  Google Scholar 

  9. Zorub DS, Martinez AJ, Nelson PB, Lam MT (1979) Invasive pituitary adenoma with abscess formation: case report. Neurosurgery 5:718–722

    Article  CAS  PubMed  Google Scholar 

  10. Nelson PB, Haverkos H, Martinez AJ, Robinson AG (1983) Abscess formation within pituitary tumors. Neurosurgery 12:331–333

    Article  CAS  PubMed  Google Scholar 

  11. Jadhav RN, Dahiwadkar HV, Palande DA (1998) Abscess formation in invasive pituitary adenoma: case report. Neurosurgery 43:616–619

    Article  CAS  PubMed  Google Scholar 

  12. Sharma MC, Arora R, Mahapatra AK, Sarat-Chandra P, Gaikwad SB, Sarkar C (2000) Intrasellar tuberculoma—an enigmatic pituitary infection: a series of 18 cases. Clin neurol neurosur 102:72–77

    Article  CAS  Google Scholar 

  13. Zhang X, Li Q, Hu P, Cheng H, Huang G (2002) Two case reports of pituitary adenoma associated with Toxoplasma gondii infection. J Clin Pathol 55:965–966

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Jaiswal AK, Mahapatra AK, Sharma MC (2004) Pituitary abscess associated with prolactinoma. J Clin Neurosci 11:533–534. doi:10.1016/j.jocn.2003.07.010

    Article  PubMed  Google Scholar 

  15. 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. doi:10.1007/s11102-006-8327-z

    Article  PubMed  Google Scholar 

  16. Hatiboglu MA, Iplikcioglu AC, Ozcan D (2006) Abscess formation within invasive pituitary adenoma. J Clin Neurosci 13:774–777. doi:10.1016/j.jocn.2005.11.031

    Article  PubMed  Google Scholar 

  17. Salinas-Lara C, Rembao-Bojorquez D, de la Cruz E, Marquez C, Portocarrero L, Tena-Suck ML (2008) Pituitary apoplexy due to mucormycosis infection in a patient with an ACTH producing pulmonary tumor. J Clin Neurosci 15:67–70. doi:10.1016/j.jocn.2006.01.023

    Article  PubMed  Google Scholar 

  18. Ciappetta P, Calace A, D’Urso PI, De Candia N (2008) Endoscopic treatment of pituitary abscess: two case reports and literature review. Neurosurg Rev 31:237–246. doi:10.1007/s10143-007-0096-2 Discussion 246

    Article  PubMed  Google Scholar 

  19. Bakker NA, Hoving EW (2010) A rare case of sudden blindness due to a pituitary adenoma coincidentally infected with methicillin-resistant Staphylococcus aureus (MRSA). Acta Neurochir 152:1079–1080. doi:10.1007/s00701-009-0551-7

    Article  PubMed Central  PubMed  Google Scholar 

  20. Kuge A, Sato S, Takemura S, Sakurada K, Kondo R, Kayama T (2011) Abscess formation associated with pituitary adenoma: a case report: changes in the MRI appearance of pituitary adenoma before and after abscess formation. Surg Neurol Int 2:3. doi:10.4103/2152-7806.76140

    Article  PubMed Central  PubMed  Google Scholar 

  21. Kotani H, Abiru H, Miyao M, Kakimoto Y, Kawai C, Ozeki M, Tsuruyama T, Tamaki K (2012) Pituitary abscess presenting a very rapid progression: report of a fatal case. Am J Forensic Med Pathol 33:280–283. doi:10.1097/PAF.0b013e3182557dcf

    Article  PubMed  Google Scholar 

  22. Wolansky LJ, Gallagher JD, Heary RF, Malantic GP, Dasmahapatra A, Shaderowfsky PD, Budhwani N (1997) MRI of pituitary abscess: two cases and review of the literature. Neuroradiology 39:499–503

    Article  CAS  PubMed  Google Scholar 

  23. Celikoglu E, Boran BO, Bozbuga M (2006) Abscess formation in Rathke’s cleft cyst. Neurol India 54:213–214

    PubMed  Google Scholar 

  24. Ramadan HH (1995) What is the bacteriology of chronic sinusitis in adults? Am J Otolaryngol 16:303–306

    Article  CAS  PubMed  Google Scholar 

  25. Bjerre P, Riishede J, Lindholm J (1983) Pituitary abscess. Acta Neurochir 68:187–193

    Article  CAS  PubMed  Google Scholar 

  26. Salehi F, Agur A, Scheithauer BW, Kovacs K, Lloyd RV, Cusimano M (2009) Ki-67 in pituitary neoplasms: a review-part I. Neurosurgery 65:429–437. doi:10.1227/01.NEU.0000349930.66434.82 Discussion 437

    Article  PubMed  Google Scholar 

  27. Scheithauer BW, Kurtkaya-Yapicier O, Kovacs KT, Young WF Jr, Lloyd RV (2005) Pituitary carcinoma: a clinicopathological review. Neurosurgery 56:1066–1074 Discussion 1066-1074

    PubMed  Google Scholar 

  28. Tarapore PE, Sughrue ME, Blevins L, Auguste KI, Gupta N, Kunwar S (2011) Microscopic endonasal transsphenoidal pituitary adenomectomy in the pediatric population. J Neurosurg Pediatr 7:501–509. doi:10.3171/2011.2.PEDS10278

    PubMed  Google Scholar 

  29. Wilson PJ, De-Loyde KJ, Williams JR, Smee RI (2012) A single centre’s experience of stereotactic radiosurgery and radiotherapy for non-functioning pituitary adenomas with the Linear Accelerator (Linac). J Clin Neurosci 19:370–374. doi:10.1016/j.jocn.2011.07.025

    Article  CAS  PubMed  Google Scholar 

  30. Jahangiri A, Wagner JR, Pekmezci M, Hiniker A, Chang EF, Kunwar S, Blevins L, Aghi MK (2013) A comprehensive long-term retrospective analysis of silent corticotrophic adenomas versus hormone-negative adenomas. Neurosurgery. doi:10.1227/NEU.0b013e31828ebfce

    Google Scholar 

  31. 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

    CAS  PubMed  Google Scholar 

  32. Takao H, Doi I, Watanabe T (2006) Diffusion-weighted magnetic resonance imaging in pituitary abscess. J Comp Assist Tomogr 30:514–516

    Article  Google Scholar 

  33. 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. doi:10.1007/s10143-006-0021-0

    Article  PubMed  Google Scholar 

  34. Jahangiri A, Lamborn KR, Blevins L, Kunwar S, Aghi MK (2012) Factors associated with delay to pituitary adenoma diagnosis in patients with visual loss. J Neurosurg 116:283–289. doi:10.3171/2011.6.JNS101663

    Article  PubMed  Google Scholar 

  35. Jahangiri A, Clark AJ, Han SJ, Kunwar S, Blevins LS, Aghi MK (2013) Socioeconomic factors associated with pituitary apoplexy. J Neurosurg. doi: 10.3171/2013.6.JNS122323

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Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this case report or the findings specified in this paper.

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Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine

    Ahmed J. Awad

  2. California Center for Pituitary Disorders, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA

    Nathan Christopher Rowland & Matthew Tate

  3. Department of Neurological Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Matthew Mian

  4. Department of Pathology, University of California, San Francisco, San Francisco, CA, USA

    Annie Hiniker

  5. California Center for Pituitary Disorders and Center for Minimally Invasive Skull Base Surgery, Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Rm M-779, San Francisco, CA, 94143-0112, USA

    Manish Kumar Aghi

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  1. Ahmed J. Awad
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  2. Nathan Christopher Rowland
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  3. Matthew Mian
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  4. Annie Hiniker
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  5. Matthew Tate
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  6. Manish Kumar Aghi
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Correspondence to Manish Kumar Aghi.

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Awad, A.J., Rowland, N.C., Mian, M. et al. Etiology, prognosis, and management of secondary pituitary abscesses forming in underlying pituitary adenomas. J Neurooncol 117, 469–476 (2014). https://doi.org/10.1007/s11060-013-1285-1

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  • DOI: https://doi.org/10.1007/s11060-013-1285-1

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