Pituitary abscess: a series of six cases

Abstract

Pituitary abscess is a rare condition occurring in various age groups. Only about a hundred cases have been reported in the literature. We describe six cases that constitute 0.6% of all the pituitary lesions operated at this centre in the last 10 years. All the patients presented with visual symptoms, though systemic features of infection were present in only two cases. The abscess was seen in association with adenoma in two cases and Rathke's cleft cyst in one. One patient developed an abscess following surgery for pituitary adenoma. The offending organisms was fungal in two cases, mycobacterium in one, bacterial in one and two cultures were sterile. Preoperative diagnosis is difficult and a high degree of suspicion in ring enhancing lesions of the sella is required.

Pituitary Abscess Mimicking a Pituitary Adenoma Presenting with Secondary Amenorrhea and Blurring of Vision: A Case Report

“…3 It may occur in a previously healthy patient without pre-existing infection or pituitary gland lesion such as an adenoma. 4 In a review of 24 cases done by Vates, the most common clinical presentations were non-specific headache, pituitary dysfunction, and visual disturbances. 5 In a review of 33 cases done by Fuyi, the most common presenting symptoms of pituitary abscess are panhypopituitarism, diabetes insipidus (DI), and nonspecific headache.…”

Primary pituitary abscess followed by empty sella syndrome in an adolescent girl

“…The mechanisms involved in the development of pituitary infection are complex such as propagation of a regional infection (sphenoid sinusitis, cavernous sinus thrombophlebitis, meningitis, or following tooth extraction) to the pituitary gland [14][15][16][17][18] or systemic microbial population of the pituitary tissue (sepsis) [19]; seldom, infection follows a neurosurgical trans-sphenoidal or transcranial approach of the pituitary gland [1]. Our case represents a primary pituitary abscess seen in adolescence, without an identifiable source of infection.…”

“…Scarce epidemiological data are available, suggesting that pituitary abscesses represent not more than 0.2-1% of all pituitary lesions [1][2][3][4].…”

Rathke’s Cleft Cyst Abscess

“…Abscess formation within a RCC is an extremely rare occurrence with only 6 other cases reported in the English literature [1, 4, 7, 12, 13]all occurring in adults. Three other cases have been reported in the non-English literature [3, 5, 9].…”

“…Abscess contents were sterile in at least three reports [4, 9, 12]although in one, Gram-negative rods were identified [12]. Concerning the various organisms that have been isolated ( A. lwoffii, Staphylococcus epidermidis [7], Staphylococcus aureus and Streptococcus pyogenes [1]), these neither offer any clue as to a common source of infection, nor do they contribute toward understanding the mechanism for infecting a RCC.…”