Endocrinol Metab.  2011 Mar;26(1):72-77. 10.3803/EnM.2011.26.1.72.

A Case of Pituitary Abscess that was Difficult to Diagnose due to Repeated Symptomatic Responses to Every Corticosteroid Administration

• Jang JS
• Yun JS
• Shin JA
• Kim MH
• Lim DJ
• Cho JH
• Yoon KH
• Kang MI
• Cha BY
• Son HY
• Hong YK

• KMID: 2169128
• DOI: http://doi.org/10.3803/EnM.2011.26.1.72

Abstract

Pituitary abscess is a rare pathology, but it is a potentially life-threatening condition. Therefore, timely intervention, including antibiotics and an operation, can prevent the morbidity and mortality in such cases. A 31-year-old woman, who was 16 months after her second delivery, presented with intermittent headache for 3 months. Amenorrhea, polyuria and polydipsia were noticed and the endocrinological hormone studies were compatible with panhypopituitarism and diabetes insipidus. Pituitary MRI demonstrated a 2.3 cm sized cystic mass with an upper small nodular lesion. Her symptoms such as headache and fever were repeatedly improved whenever corticosteroid was administered, which led us to suspect the diagnosis of an inflammatory condition like lymphocytic hypophysitis. During the hormone replacement therapy, her cystic pituitary mass had grown and her symptoms progressively worsened for another two months. The patient underwent trans-sphenoidal exploration and she turned out to have a pituitary abscess. At the 3-month follow-up, amenorrhea was noticed and her residual function of the pituitary was tested by a combined pituitary stimulation test. The results were compatible with panhypopituitarism. She received levothyroxine 100 microg, prednisolone 5 mg and desmopressin spray and she is being observed at the out-patient clinic. The authors experienced a patient with primary pituitary abscess that was confirmed pathologically and we report on its clinical course with a literature review.

Keyword

Corticosteroids; Panhypopituitarism; Pituitary abscess

MeSH Terms

Abscess
Adrenal Cortex Hormones
Adult
Amenorrhea
Anti-Bacterial Agents
Deamino Arginine Vasopressin
Diabetes Insipidus
Female
Fever
Follow-Up Studies
Headache
Hormone Replacement Therapy
Humans
Hypopituitarism
Outpatients
Polydipsia
Polyuria
Prednisolone
Thyroxine
Adrenal Cortex Hormones
Anti-Bacterial Agents
Deamino Arginine Vasopressin
Prednisolone
Thyroxine

Figure

• 

  Fig. 1 Sella MRI; upper panels, T1-weighted images; lower panels, enhanced T1-weighted images. Initial sagittal images (A, D) show a 1.4 × 2.3 × 2.2 cm sized cystic mass (thin arrow) in sellar and suprasellar region with thickened stalk and a 1.4 cm sized enhancing nodular lesion (thick arrow) above the mass. 2 months later, preoperative sagittal images (B, E) show significant increase in size, extent and signal intensity of the cystic mass (thin arrow) and nodular contrast-enhancing lesion (thick arrow) on upper margin of the mass. Post-operative images (C, F) show that pituitary abscess was completely removed and normal pituitary gland was remaining with enhancement by gadolinium, along with pituitary stalk.

• 

  Fig. 2 Histology of the pituitary abscess. A, B. Polymorphonuclear neutrophil and fibrous tissue showing mild acute and chronic inflammation with focal necrosis and calcification (H&E staining, A, × 40, B, × 200).

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