Pituitary Abscess: A Rare Clinical Entity in the Presence of Acute Rhinosinusitis: A Case Report

Anagnos, Vincent John; Hanel, Ricardó A.; Naseri, Iman

doi:10.1055/s-0038-1656531

Cited by 8 publications

(2 citation statements)

References 18 publications

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“…Protecting normal pituitary tissue and preventing damage to the sellar diaphragm is necessary to avoid cerebrospinal uid rhinorrhea and intracranial infection. Check the abscess cavity if a pituitary adenoma is present [43] . The pus obtained during surgery must undergo routine microbiological analysis.…”

Section: Treatment Recommendations and Outcomesmentioning

confidence: 99%

Pituitary abscess: A descriptive analysis of a series of 19 patients: a multi-center experience

Qin¹,

Shi

et al. 2023

Preprint

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Object: The study aims to investigate the intractable pituitary abscess (PA) diagnosis and assess the significance of combined intraoperative surgery with postoperative antibiotic treatment. Method: We retrospectively analyzed 19 pituitary abscess patients confirmed by histopathology, all consecutive patients who underwent transsphenoidal surgery (TSS) as pituitary adenomas after accepting comprehensive preoperative inspections, including routine tests, endocrine assay, and imaging examination. Result: Other sellar lesions were misdiagnosed prior to surgery. The favorable prognosis was largely due to surgical and active postoperative antibiotic therapy. Conclusion: Due to the lack of clarity in preoperative diagnosis, typical intraoperative findings and effective antibiotics are more indicative of the correct diagnosis than other tests. When it comes to therapy, optimal surgical and postoperative active antibiotic treatment benefits the PA dilemma.

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Section: Treatment Recommendations and Outcomesmentioning

confidence: 99%

Pituitary abscess: A descriptive analysis of a series of 19 patients: a multi-center experience

Qin¹,

Shi

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…2 Other complications include brain abscess, subdural empyema, cavernous sinus thrombosis, epidural abscess, osteomyelitis, and pituitary abscess has also been reported as an extremely rare finding. 3 A multidisciplinary approach is preferred for treating these patients.…”

Section: Introductionmentioning

confidence: 99%

Invasive Cryptococcal Meningitis Presenting as a Skull Base Mass in An Immunocompetent Host: A Case Report

et al. 2019

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Introduction Encephalitis due to Cryptococcus neoformans has been seen almost exclusively in patients with severe compromise of their immune systems, such as acquired immune deficiency syndrome (AIDS). Fungal sinusitis with frank invasion through the cranial base and subsequent seeding of the central nervous system is rare, but should be considered in the differential of patients presenting with meningitis and sinus/skull base lesions even without obvious immune compromise. Improvements in diagnostic testing has increased the ability to correctly identify and new antimicrobials have allowed a condition that once carried a high morbidity and mortality to be managed with better outcomes. We present our treatment algorithm for successful management of an immunocompetent patient with extensive fungal encephalitis due to erosion through the skull base. Case Description The patient is a 59-year-old male presenting unresponsive with sphenoid mass erosive of the skull base and symptoms of meningitis and encephalitis due to C. neoformans. Magnetic resonance imaging (MRI) at presentation demonstrated extensive diencephalic invasion, and a sphenoid mass with erosion of the skull base. Lumbar puncture (LP) confirmed elevated opening pressure of 45 cm H2O, and cultures confirmed infection with C. neoformans. He underwent operative sinonasal debridement followed by placement of an external ventricular drain for management of hydrocephalus. He was treated aggressively with a combination of both intravenous (IV) amphotericin B daily and intrathecal amphotericin B via the ventriculostomy thrice weekly. By the 2nd week of treatment, patient regained consciousness. After 4 weeks of therapy, cerebrospinal fluid (CSF) cultures turned negative, and the external ventricular drain (EVD) was converted to a ventriculoperitoneal shunt (VPS) to manage chronic postinfectious hydrocephalus. We also placed a contralateral Ommaya reservoir to permit continued weekly intrathecal amphotericin B without violation of the shunt valve. With each instillation, the shunt was set to its highest setting to minimize CSF egress for 6 hours then reset to its “drainage” setting. After an additional 6 weeks of outpatient therapy, intrathecal therapy was discontinued. We continued CSF surveillance via Ommaya sampling monthly. At 9-month follow-up, he has remained clinically stable without evidence of recurrent infection. He has residual mild cognitive deficits, but is living semiindependently with his brother. Conclusions Fungal sinusitis is uncommon, especially in those without significantly compromised immune systems. Invasive fungal meningitis resulting in meningitis and encephalitis is even rarer. The condition carries high morbidity and mortality that can only be mitigated with a multidisciplinary effort by neurosurgery, otolaryngology, and infectious disease specialists. While there are no clear treatment guidelines, we present an approach that may permit longer term independent survival.

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Hypothalamic-pituitary abscess as a complication of acute sinusitis: A case report and evolution with conservative management

Céspedes¹,

Millán²,

Roselló³

et al. 2021

Endocrinología, Diabetes y Nutrición (English ed.)

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Pituitary Abscess: A Rare Clinical Entity in the Presence of Acute Rhinosinusitis: A Case Report

Cited by 8 publications

References 18 publications

Pituitary abscess: A descriptive analysis of a series of 19 patients: a multi-center experience

Pituitary abscess: A descriptive analysis of a series of 19 patients: a multi-center experience

Invasive Cryptococcal Meningitis Presenting as a Skull Base Mass in An Immunocompetent Host: A Case Report

Hypothalamic-pituitary abscess as a complication of acute sinusitis: A case report and evolution with conservative management

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