Case Report of a Primary Pituitary Abscess and Systematic Literature Review of Pituitary Abscess with a Focus on Patient Outcomes.
BACKGROUND
Pituitary abscess is a rare but potentially life-threatening condition with an incidence of 0.2%-1.1% of operative pituitary lesions. Diagnosis can be challenging, because this disorder shares many similarities with other pituitary lesions in terms of signs and symptoms and radiographic findings. Most pituitary abscesses are categorized as secondary, arising from preexisting pituitary lesions or in conjunction with transsphenoidal surgery, sepsis, meningitis, or sinusitis. There have been only a few reports of primary pituitary abscess, which occurs without any of the aforementioned risk factors.


METHODS
We present a case of primary pituitary abscess in a 38-year-old woman with headaches, blurry vision, polyuria, and polydipsia who was found to have hypopituitarism. Brain magnetic resonance imaging showed a sellar/suprasellar mass, which was endoscopically resected via a transsphenoidal approach. Egress of yellow-greenish creamy fluid was noted on dural incision. The patient was treated with a 6-week course of antibiotic therapy postoperatively and had resolution of symptoms.


CONCLUSIONS
A PubMed search was performed; all cases of pituitary abscess reported in the literature were screened, and 200 cases including our case were analyzed with a focus on outcomes. The most common presentations were headache, visual disturbance, and endocrine abnormalities. Approximately 66.1% of patients achieved partial or complete recovery of pituitary function; 75.7% with vision deficits recovered visual function. Treatment via a craniotomy had a recurrence rate of 17.2% compared with 9.7% via a transsphenoidal approach. To our knowledge, this is the first systematic review on the topic and the largest series reported.
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center and Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
Justice O
JO
Agyei
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center and Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
Lindsay J
LJ
Lipinski
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center and Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA. Electronic address: editorial@ubns.com.
Jody
J
Leonardo
D000038:Abscess / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D003399:Craniotomy; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D004724:Endoscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010468:Perceptual Disorders / Q000209:etiology*; D010902:Pituitary Gland; D014794:Visual Fields / Q000502:physiology
Antibiotic therapy; Endoscopic transsphenoidal resection; Pituitary abscess