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Endoscopic treatment of pituitary abscess: two case reports and literature review

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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

  1. 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

    CAS  Google Scholar 

  2. Arseni C, Danaila L, Carp N, Ghitescu M, Istrati C (1975) Intrasellar abscess. Neurochirurgia (Stuttg) 18:207–213

    CAS  Google Scholar 

  3. Asenjo A (1954) Operierter pneumakokken-abzess in einem transitions-hypophysen-adenom [in German]. Acta Neurochir 3:100–103

    Article  Google Scholar 

  4. Askenasy HM, Israeli J, Karny H, Dujovny M (1971) Intrasellar abscess simulating pituitary adenoma. Neurochirurgia 14:34–37

    PubMed  CAS  Google Scholar 

  5. Barrada Y, Guinea Y, Abd El Naby S, Taher Y (1952) Intra-sellar abscess simulating chromophobe adenoma. J Egypt Med Assoc 35:105–112

    PubMed  CAS  Google Scholar 

  6. Bianchi NO, Cabarrou A, Caino HV, Burry C, Baylon N (1961) Abscess of the pituitary gland. Prensa Med Argent 7(48):876–881

    Google Scholar 

  7. Bognar L, Szeifert GT, Fedorcsak I, Pasztor E (1992) Abscess formation in Rathke’s cleft cyst. Acta Neurochir (Wien) 117:70–72

    Article  CAS  Google Scholar 

  8. 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

    PubMed  CAS  Google Scholar 

  9. 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

    Google Scholar 

  10. 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

    PubMed  CAS  Google Scholar 

  11. 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

    PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  13. De Villiers Hamman H (1956) Abscess formation in the pituitary fossa ssociated with a pituitary adenoma. J Neurosurg 13:208–210

    Google Scholar 

  14. 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

    CAS  Google Scholar 

  15. Diaz-Aramendi A, Garibi J, Zorrilla J, Aurrechoechea J, Claro T (1993) Pituitary abscess. Neurochirurgie 39:125–127

    PubMed  CAS  Google Scholar 

  16. Dickob M, Scharphuis T, Distelmaier P, Hoffmann G (1989) Diagnosis of hypophyseal abscess using MRI and high resolution CT. Neurochirurgia (Stuttg) 32:184–186

    CAS  Google Scholar 

  17. Domingue JN, Wilson CB (1977) Pituitary abscess: report of seven cases and review of literature. J Neurosurg 46:601–608

    PubMed  CAS  Google Scholar 

  18. Donnet A, Trefouret S, Millet Y, Grisoli F (1999) Pituitary abscess revealed by sleep attacks. Surg Neurol 51:564–565

    Article  PubMed  CAS  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. Ekelund C (1945) Om en akuta hypophysiten och dess relation till Simmond’s Syndrom[in swedish]. Nord Med 28:2640–2642

    Google Scholar 

  21. 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

    Google Scholar 

  22. Feely M, Steinberg M (1977) Aspergillus infection complicating trassphenoidal yttrium-90 pituitary implant. Report of two cases. J Neurosurg 46:530–532

    PubMed  CAS  Google Scholar 

  23. Ford J, Torres LF, Cox T, Hayward R (1986) Recurrent sterile meningitis caused by a pituitary abscess. Postgrad Med J 62:929–931

    PubMed  CAS  Google Scholar 

  24. 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

    Google Scholar 

  25. Gokalp HZ, Deda H, Baskaya MK, Bulay O, Erekul S (1994) Pituitary abscesses. Report of three cases. Neurosurg Rev 17:199–203

    Article  PubMed  CAS  Google Scholar 

  26. Gomez Perun J, Eiras J, Carcavilla LI (1981) Intrasellar abscess into a cyst of the Rathke’s pouch (author translation). Neurochirurgie 27:201–205

    PubMed  CAS  Google Scholar 

  27. 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

    PubMed  CAS  Google Scholar 

  28. Güven MB, Cirak B, Kutluhan A, Ugras S (1999) Pituitary abscess secondary to neurobrucellosis. J Neurosurg 90:1142

    PubMed  Google Scholar 

  29. Hanel RA, Koerbel A, Prevedello DM, Moro MS, Araujo JC (2002) Primary pituitary adenoma. Arq Neuro-Psiquiatr 60:861–865

    Article  Google Scholar 

  30. Har-El G, Swanson RM, Kent RH (1996) Unusual presentation of a pituitary abscess. Surg Neurol 45:351–353

    Article  PubMed  CAS  Google Scholar 

  31. Hatiboglu MA, Iplikcioglu AC, Ozcan D (2006) Abscess formation within invasive pituitary adenoma. J Clin Neurosci 13:774–777

    Article  PubMed  Google Scholar 

  32. Heary RF, Maniker AH, Wolansky LJ (1995) Candidal pituitary abscess: case report. Neurosurgery 36:1009

    Article  PubMed  CAS  Google Scholar 

  33. Henegar MM, Koby MB, Silbergeld DL, Rich KM, Moran CJ (1996) Intrasellar abscess following transsphenoidal surgery. Surg Neurol 45:183–188

    Article  PubMed  CAS  Google Scholar 

  34. Hernandez I, Garcia L, Guinto G, Cabrera L, Mercado M (2002) Bacterial pituitary abscess: an unusual cause of panhypopituitarism. Endocr Pract 8:424–428

    PubMed  Google Scholar 

  35. Heslop TP (1848) A case of hypertrophy with abscess of the pituitary body. Dublin Quart J M 6:466

    Google Scholar 

  36. Holck S, Laursen H (1983) Prolactinoma coexistent with granulomatous hypophysitis. Acta Neuropathol (Berl) 61:253–257

    Article  CAS  Google Scholar 

  37. Hon CS, Knuckey N, Robbins P, Pullan PT (1999) Pituitary abscess. J Clin Neurosci 6(4):351–353

    Article  PubMed  Google Scholar 

  38. Jadhav RN, Dahiwadkar HV, Palande DA (1998) Abscess formation in invasive pituitary adenoma: case report. Neurosurgery 3:616–622

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  40. Jaiswal AK, Mahapatra AK, Sharma MC (2004) Pituitary abscess associated with prolactinoma. J Clin Neurosci 11:533–534

    Article  PubMed  Google Scholar 

  41. 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

    PubMed  CAS  Google Scholar 

  42. Kaur A, Agrawal A, Mittal M (2005) Presumed pituitary abscess without infectious source treated successfully with antibiotics alone. J Neuroophthalmol 25:185–188

    PubMed  Google Scholar 

  43. 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

    PubMed  CAS  Google Scholar 

  44. 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

    Article  PubMed  CAS  Google Scholar 

  45. Leff RS, Martino RL, Pollock WJ, Knight WA (1989) Pituitary abscess after autologous bone marrow transplantation. Am J Hematol 31:62–64

    Article  PubMed  CAS  Google Scholar 

  46. Leramo OB, Char G (1989) Intrasellar abscess simulating a pituitary tumour. West Indian Med J 38:171–175

    PubMed  CAS  Google Scholar 

  47. Lindholm J, Rasmussen P, Korsgaard O (1973) Intrasellar or pituitary abscess. J Neurosurg 38:616–619

    PubMed  CAS  Google Scholar 

  48. Marks PV, Furneaux CE (1984) Pituitary abscess following asymptomatic sphenoid sinusitis. J Laryngol Otol 98:1151–1155

    PubMed  CAS  Google Scholar 

  49. 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

    PubMed  CAS  Google Scholar 

  50. Matsuno A, Ogino Y, Katayama H, Nagashima T (2005) Pituitary abscess in a patient with painless thyroiditis. J Clin Neurosci 12:190–193

    Article  PubMed  Google Scholar 

  51. Medoc J, Purriel JA, Leiserson R (1966) Abscess of the pituitary gland and purulent meningitis. Acta Neurol Latinoam 12:71–75

    PubMed  CAS  Google Scholar 

  52. Montrieul B, Janny P, Pignide L, Chabannes J (1965) Observations on hypophyseal abscesses (in French). Neurochirurgie 11:366–371

    PubMed  CAS  Google Scholar 

  53. Neelon FA, Mahaley MS (1976) Chiasmal syndrome due to intrasellar abscess. Arch Intern Med 136:1041–1043

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  55. 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

    Article  PubMed  Google Scholar 

  56. Obenchain TG, Becker DP (1972) Abscess formation in a Rathke’s cleft cyst. Case report. J Neurosurg 36:359–362

    PubMed  CAS  Google Scholar 

  57. Obrador S, Blazquez MG (1972) Pituitary abscess in a craniopharyngioma. J Neuorsurg 36:785–789

    CAS  Google Scholar 

  58. 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

    Article  PubMed  CAS  Google Scholar 

  59. Reddy K, Fewer D, West M (1991) Complications of the transsphenoidal approach to sellar lesions. Can J Neurol Sci 18:463–466

    PubMed  CAS  Google Scholar 

  60. Riser M, Lazorthes G, Anduze-Acher H (1956) Les abcès de l’hypophyse (in French). Rev Oto-neuro-ophthal 28:494–496

    CAS  Google Scholar 

  61. Robinson B (1983) Intrasellar abscess after transsphenoidal pituitary adenomectomy. Neurosurgery 12:684–686

    Article  PubMed  CAS  Google Scholar 

  62. Rongetti JR, Daniels JT (1950) Treatment of empyema of the sella turcica of sphenoid origin. Arch Otolaryngol 52:166–171

    PubMed  CAS  Google Scholar 

  63. 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

    PubMed  CAS  Google Scholar 

  64. 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

    Article  PubMed  CAS  Google Scholar 

  65. Scanarini M, Rotilio A, Rigobello L, Pomes A, Parenti A, Alessio L (1991) Primary intrasellar coccidioidomycosis simulating a pituitary adenoma. Neurosurgery 28:748–751

    Article  PubMed  CAS  Google Scholar 

  66. Schwartz ID, Zalles MC, Foster JL, Burry VF (1995) Pituitary abscess: an unusual presentation of “aseptic meningitis”. J Pediatr Endocrinol Metab 8:141–146

    PubMed  CAS  Google Scholar 

  67. Selosse P, Mahler C, Klaes RL (1980) Pituitary abscess. Case report. J Neurosurg 53:851–852

    PubMed  CAS  Google Scholar 

  68. Shanley DJ, Holmes SM (1994) Salmonella typhi abscess in a craniopharyngioma: CT and MRI. Neuroradiology 36:35–36

    Article  PubMed  CAS  Google Scholar 

  69. 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

    PubMed  CAS  Google Scholar 

  70. Simmonds M (1914) Zur Pathologie der Ag hypophysis (in German). Verh Dtsch Pathol 17:208–212

    Google Scholar 

  71. 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

    CAS  Google Scholar 

  72. Svein HJ, Love JG (1942) Abscess within the sella turcica simulating pituitary tumor: surgical cure. Mayo Clin Proc 17:497–501

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  74. 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

    Article  PubMed  Google Scholar 

  75. 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

    PubMed  CAS  Google Scholar 

  76. 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

    PubMed  CAS  Google Scholar 

  77. 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

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  80. 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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

We are grateful to Mrs. Chrissie Oppedisano for the English revision.

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Authors and Affiliations

  1. Section of Neurosurgery, Department of Neurological Sciences, University of Bari Medical School, Piazza Giulio Cesare, 11, 70124, Bari, Italy

    Pasqualino Ciappetta, Antonio Calace & Pietro Ivo D’Urso

  2. Otorhinolaryngoiatry Clinic, Department of Ophthalmology and Otorhinolaryngology, University of Bari Medical School, Bari, Italy

    Nicola De Candia

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  1. Pasqualino Ciappetta
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Correspondence to Pietro Ivo D’Urso.

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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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