title: Pituitary abscess: clinical manifestations, diagnosis and treatment of 66 cases from a large pituitary center over 23 years.
abstract: OBJECTIVE
  Pituitary abscess (PA) is rare and commonly described in case reports or small case series. This study aimed to better determine salient clinical manifestations related to the diagnosis and appropriate treatment of PA using by far the largest case series of this disease.
  
  
  METHODS
  A total of 6361 consecutive patients underwent surgery for pituitary diseases in Peking Union Medical College Hospital between January 1991 and December 2013. Among this cohort, sixty-six patients were diagnosed with PA based on both intraoperative findings and postoperative histopathological evidence.
  
  
  RESULTS
  The most common clinical presentation was anterior pituitary hypofunction (81.8 %), followed by common headache (69.7 %), diabetes insipidus (DI; 47.9 %), visual disturbances (45.5 %) and symptoms related to infection (43.9 %). Forty patients (66.7 %) showed typical rim enhancement after gadolinium injection on magnetic resonance imaging (MRI). Most patients (63 of 66, 95.5 %) underwent transsphenoidal surgery (TSS), and the remaining 3 patients (4.5 %) were treated with transcranial surgery (TC). After follow-up for 7.2 ± 4.9 years, PA was diminished in most patients (81.8 %), as demonstrated by post-operative MRI, and eight patients underwent at least one additional operation due to recurrence.
  
  
  CONCLUSIONS
  For patients with hypopituitarism and DI with rim enhancement on MRI, we should consider the possible diagnosis of PA. Proper use of antibiotics, complete drainage via surgery and hormone replacement for hypopituitarism are the key treatments for PA.
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.|China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.|China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
authors.forename: Xiaopeng
authors.initials: X
authors.lastname: Guo
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.|China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Tian
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.|China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.|China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Feng
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.|China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
authors.forename: Xinjie
authors.initials: X
authors.lastname: Bao
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.|China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
authors.forename: Kan
authors.initials: K
authors.lastname: Deng
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.|China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yao
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.|China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Lian
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.|China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
authors.forename: Renzhi
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China. xingbingemail@aliyun.com.|China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China. xingbingemail@aliyun.com.
authors.forename: Bing
authors.initials: B
authors.lastname: Xing
mesh_terms: D000328:Adult; D000368:Aged; D001922:Brain Abscess / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010900:Pituitary Diseases / Q000175:diagnosis* / Q000601:surgery; D012189:Retrospective Studies
keywords: Diagnosis; Pituitary abscess; Transsphenoidal surgery; Treatment