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Table of Contents    
NEUROIMAGE
Year : 2015  |  Volume : 63  |  Issue : 6  |  Page : 1000-1001

Primary pituitary abscess


1 Department of Neurosurgery, Sichuan Provincial People's Hospital, Sichuan University, Chengdu - 610 041, Sichuan; Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu - 610 041, Sichuan, China
2 Department of Neurosurgery, West Hospital, Sichuan University, Chengdu  -  610  041, Sichuan, China

Date of Web Publication20-Nov-2015

Correspondence Address:
Dr. Chao You
37 Guoxuexiang Street, Chengdu, Sichuan
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.170078

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How to cite this article:
Liu J, You C. Primary pituitary abscess. Neurol India 2015;63:1000-1

How to cite this URL:
Liu J, You C. Primary pituitary abscess. Neurol India [serial online] 2015 [cited 2019 Dec 14];63:1000-1. Available from: http://www.neurologyindia.com/text.asp?2015/63/6/1000/170078


Primary pituitary abscess is a rare disease entity, mainly presenting with a chronic and indolent course, and mimics a pituitary tumor.[1] The preoperative diagnosis is usually challenging. We present a rare case of de novo pituitary abscess that did not have any other predisposing etiology but presented with a classical magnetic resonance imaging (MRI) image. A 54-year-old man complained of headache, polydipsia, and diuresis for 6 months. These symptoms got aggravated 2 weeks before admission and the patient also experienced a slight visual deterioration. A cranial MRI examination demonstrated an intrasellar mass with peripheral ring enhancement [Figure 1]a,[Figure 1]b,[Figure 1]c. Preoperative diabetes insipidus is relatively rare in a pituitary adenoma.[2] Considering the imageology, a pituitary abscess was considered and antibiotic therapy was given immediately. A transsphenoidal surgery was conducted 3 days later. During the surgery, an enlarged sphenoid sinus with papery thin sellar floor was noted. When the dura was entered, yellowish pus was found and drained. The pus culture revealed the finding of Gram-positive Staphylococcus. Vancomycin was started intravenously twice a day for 2 weeks after the operation. The patient was free of headache soon after the operation, and his vision improved gradually but the diabetes insipidus persisted. His postoperative course was otherwise uneventful except for his dependence on desmopressin acetate, which was still being continued at 3 years of follow-up.
Figure 1: Cranial magnetic resonance imaging, sagittal section showing a sellar cystic mass with a clear enhanced rim; the pituitary stalk is invaded (a and c); coronal section showing the pituitary mass with suprasellar extension and the optic chiasm being elevated by it (b)

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Pituitary abscess often has a chronic and indolent clinical course without infective signs. Vision disturbances, hypopituitarism, and the presence of a sellar mass with an enhancing ring on cranial MRI images are its major diagnostic features.[3]

Financial support and sponsorship

The study was supported by the health and family planning commission of Sichuan Province, program number: 140083.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

1.
Ciappetta P, Calace A, D'Urso PI, De Candia N. Endoscopic treatment of pituitary abscess: Two case reports and literature review. Neurosurg Rev 2008;31:237-46.  Back to cited text no. 1
    
2.
Dalan R, Leow MK. Pituitary abscess: Our experience with a case and a review of the literature. Pituitary 2008;11:299-306.  Back to cited text no. 2
    
3.
Liu F, Li G, Yao Y, Yang Y, Ma W, Li Y, et al. Diagnosis and management of pituitary abscess: Experiences from 33 cases. Clin Endocrinol (Oxf) 2011;74:79-88.  Back to cited text no. 3
    


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Pituitary. 2017; 20(2): 189
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