Diagnosis and management of pituitary abscess: experiences from 33 cases

Abstract

Pituitary abscess is a rare disorder with nonspecific presenting manifestations, often making a correct preoperative diagnosis difficult. To better determine the salient signs and symptoms of pituitary abscess and to evaluate the effectiveness of surgical and antibiotic therapies, we conducted a review of patients treated for pituitary abscess at the Peking Union Medical College Hospital (PUMCH). A total of 33 consecutive patients referred to PUMCH between 1991 and 2007 were included. While 30 patients underwent surgery and antibiotic therapy, three patients accepted only antibiotic therapy. A complete history, a thorough record of signs and symptoms, pituitary imaging and biochemical panels were obtained for each patient. Most of the patients presented with complaints and symptoms consistent with a sellar mass, generally in the absence of any evidence of infection. Diabetes insipidus, hypopituitarism and headache were the most common clinical indicators. Typical magnetic resonance (MR) images after gadolinium injection demonstrated a sellar cystic mass with an enhanced rim. Although there were several recurrences, the abscess resolved in nearly all cases. Hypopituitarism generally did not recover, and hormone replacement therapy was usually necessary. Presentation of diabetes insipidus, hypopituitarism and a sellar cystic mass with an enhanced rim may be suggestive of a pituitary abscess. For most patients, a transsphenoidal evacuation, followed by antibiotic therapy, is recommended. However, antibiotic therapy alone may be useful for acute cases. In our experience, pituitary abscesses can usually be treated, though the accompanying hypopituitarism is difficult to cure, and requiring lifelong hormonal replacement.