PDF herunterladen
CC BY-NC-ND 4.0 · J Neurol Surg Rep 2018; 79(02): e36-e40
DOI: 10.1055/s-0038-1656531
Case Report
Georg Thieme Verlag KG Stuttgart · New York

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

Vincent John Anagnos
1   Lake Erie College of Osteopathic Medicine, Bradenton Campus, Bradenton, Florida, United States
,
Ricardo A. Hanel
2   Department of Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, United States
,
Iman Naseri
3   Department of Surgery – Otolaryngology Head & Neck Surgery, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, United States
› Institutsangaben
Weitere Informationen

Publikationsverlauf

21. September 2017

27. Februar 2018

Publikationsdatum:
25. Mai 2018 (online)

   Lizenzen und Reprints

Abstract

A pituitary abscess is an often-overlooked diagnosis in the clinical presentation of a sellar mass. Due to its rare incidence and nonspecific presentation, diagnosis and treatment is often delayed. The authors describe a 56-year-old male patient presenting with acute onset of severe headache, visual field deficit, and radiologic findings of an expansile sellar lesion. The presenting symptoms were unremarkable for the diagnosis of meningitis, cavernous sinus thrombosis, and septicemia. Recent medical history included symptoms of rhinosinusitis on the days preceding his acute presentation. The initial clinical presentation was suggestive of a possible pituitary apoplexy. Intraoperative findings revealed purulent output upon surgical entry of the sella. Histopathology confirmed the diagnosis of a pituitary abscess. Review of the clinical and radiologic data revealed evidence of multiple opacifications within the paranasal sinuses, along with dehiscence overlying the sellar bone, supporting a diagnosis of secondary pituitary abscess. This case, along with a review of the available literature, will serve to expand our knowledge of this rare disease process that is often overlooked. Clinicians should be mindful of this condition, and include a primary versus secondary pituitary abscess in the differential workup on such cases.

Keywords

pituitary abscess - rhinosinusitis - acute sinusitis - hypopituitarism - staphylococcal epidermidis - pituitary apoplexy - brain abscess
 

  • References

  • 1 Gao L, Guo X, Tian R. , et al. Pituitary abscess: clinical manifestations, diagnosis and treatment of 66 cases from a large pituitary center over 23 years. Pituitary 2017; 20 (02) 189-194
    CrossrefPubMedGoogle Scholar
  • 2 Vates GE, Berger MS, Wilson CB. Diagnosis and management of pituitary abscess: a review of twenty-four cases. J Neurosurg 2001; 95 (02) 233-241
    CrossrefPubMedGoogle Scholar
  • 3 Wang L, Yao Y, Feng F. , et al. Pituitary abscess following transsphenoidal surgery: the experience of 12 cases from a single institution. Clin Neurol Neurosurg 2014; 124: 66-71
    CrossrefPubMedGoogle Scholar
  • 4 Dolan RW, Chowdhury K. Diagnosis and treatment of intracranial complications of paranasal sinus infections. J Oral Maxillofac Surg 1995; 53 (09) 1080-1087
    CrossrefPubMedGoogle Scholar
  • 5 Shono T, Nishio S, Muratani H, Yasuda T, Fukui M, Moutai K. Pituitary abscess secondary to isolated sphenoid sinusitis. Minim Invasive Neurosurg 1999; 42 (04) 204-206
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 6 Somali MH, Anastasiou AL, Goulis DG, Polyzoides C, Avramides A. Pituitary abscess presenting with cranial nerve paresis. Case report and review of literature. J Endocrinol Invest 2001; 24 (01) 45-50
    CrossrefPubMedGoogle Scholar
  • 7 Prevedello DM, Barges-Coll J, Fernandez-Miranda JC. , et al. Middle turbinate flap for skull base reconstruction: cadaveric feasibility study. Laryngoscope 2009; 119 (11) 2094-2098
    CrossrefPubMedGoogle Scholar
  • 8 Martín-Gandul C, Mayorga-Buiza MJ, Castillo-Ojeda E. , et al. Sequential antimicrobial treatment with linezolid for neurosurgical infections: efficacy, safety and cost study. Acta Neurochir (Wien) 2016; 158 (10) 1837-1843
    CrossrefPubMedGoogle Scholar
  • 9 Sharma N, Jaiswal AA, Banerjee PK, Garg AK. Complications of chronic suppurative otitis media and their management: a single institution 12 years experience. Indian J Otolaryngol Head Neck Surg 2015; 67 (04) 353-360
    CrossrefPubMedGoogle Scholar
  • 10 Wu X, Liu Q, Jiang X, Zhang T. Prevention options for ventriculoperitoneal shunt infections: a retrospective analysis during a five-year period. Int J Clin Exp Med 2015; 8 (10) 19775-19780
    PubMedGoogle Scholar
  • 11 Hanel RA, Koerbel A, Prevedello DM, Moro MS, Araújo JC. Primary pituitary abscess: case report. Arq Neuropsiquiatr 2002; 60 (3-B): 861-865
    CrossrefPubMedGoogle Scholar
  • 12 Wolansky LJ, Gallagher JD, Heary RF. , et al. MRI of pituitary abscess: two cases and review of the literature. Neuroradiology 1997; 39 (07) 499-503
    CrossrefPubMedGoogle Scholar
  • 13 Lin BJ, Chen YH, Chung TT, Ma HI, Chen YH. Pituitary abscess following expanding sphenoid sinus pyocele: complication of endoscopic endonasal transsphenoidal surgery. Clin Neurol Neurosurg 2013; 115 (08) 1502-1505
    CrossrefPubMedGoogle Scholar
  • 14 Kasirye Y, Epperla N, Manne JR, Bapani S, Garcia-Montilla RJ. Brain abscesses complicating acute pneumococcal meningitis during etanercept therapy. Clin Med Res 2012; 10 (04) 230-235
    CrossrefPubMedGoogle Scholar
  • 15 Dechambenoit G, Datie A, Grunitzky EK. , et al. Pituitary abscess, treated by medication [in French]. Rev Neurol (Paris) 1993; 149 (10) 567-571
    PubMedGoogle Scholar
  • 16 Kaur A, Agrawal A, Mittal M. Presumed pituitary abscess without infectious source treated successfully with antibiotics alone. J Neuroophthalmol 2005; 25 (03) 185-188
    CrossrefPubMedGoogle Scholar
  • 17 Zhu H, Gu XM, Hong J, Shen FX. Successful treatment of pituitary abscess with intravenous antibiotics: a case report and literature review. Genet Mol Res 2014; 13 (04) 10523-10528
    CrossrefPubMedGoogle Scholar
  • 18 Liu F, Li G, Yao Y. , et al. Diagnosis and management of pituitary abscess: experiences from 33 cases. Clin Endocrinol (Oxf) 2011; 74 (01) 79-88
    CrossrefPubMedGoogle Scholar
  • 19 Zhang X, Sun J, Shen M. , et al. Diagnosis and minimally invasive surgery for the pituitary abscess: a review of twenty nine cases. Clin Neurol Neurosurg 2012; 114 (07) 957-961
    CrossrefPubMedGoogle Scholar
  • 20 Agyei JO, Lipinski LJ, Leonardo J. Case report of a primary pituitary abscess and systematic literature review of pituitary abscess with a focus on patient outcomes. World Neurosurg 2017; 101: 76-92
    CrossrefPubMedGoogle Scholar