Iatrogenic Pituitary Abscess
Spontaneous pituitary abscesses are rarely encountered; they represent less than 0.6 % of patients with sellar lesions undergoing surgical resection. (See Chap. 51.)
Acquired or iatrogenic pituitary abscesses are also uncommon. They develop rarely following cerebral trauma or transsphenoidal surgery, especially in the presence of a CSF leak. Iatrogenic abscesses are usually bacterial. Risk factors for postoperative pituitary abscess include paranasal sinus disease and sphenoid sinusitis or a spontaneous or traumatic CSF leak. Sepsis is also known to be another inciting factor.
Pituitary abscesses may present clinically with headache, fever, hypopituitarism (85 %), meningitis, diabetes insipidus, visual loss, cranial nerve paresis, altered mental status, and/or toxemia.
Diabetes insipidus is relatively common in patients with sellar abscess, being present in up to 70 % at the time of diagnosis.
The most common offending bacterial organisms are staphylococcus, streptococcus, and pneumococcus species.
Only one third of patients have an increased peripheral white blood cell count.
KeywordsPituitary Abscess Infection Sella Cerebrospinal fluid leak
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