Abstract
PurposeThere is a high incidence of abnormal sphenoid sinus changes in patients with pituitary apoplexy (PA). Their pathophysiology is currently unexplored and may reflect an inflammatory or infective process. In this preliminary study, we characterised the microbiota of sphenoid sinus mucosa in patients with PA and compared findings to a control group of surgically treated non-functioning pituitary adenomas (NFPAs).MethodsIn this prospective observational study of patients undergoing trans-sphenoidal surgery for PA or NFPA, sphenoid sinus mucosal specimens were microbiologically profiled through PCR-cloning of the 16S rRNA gene.ResultsTen patients (five with PA and five with NFPAs) with a mean age of 51 years (range 23–71) were included. Differences in the sphenoid sinus microbiota of the PA and NFPA groups were observed. Four PA patients harboured Enterobacteriaceae (Enterobacter spp., N = 3; Escherichia coli, N = 1). In contrast, patients with NFPAs had a sinus microbiota more representative of health, including Staphylococcus epidermidis (N = 2) or Corynebacterium spp. (N = 2).ConclusionsPA may be associated with an abnormal sphenoid sinus microbiota that is similar to that seen in patients with sphenoid sinusitis.
Highlights
Pituitary apoplexy (PA) is an acute clinical syndrome secondary to haemorrhage and/or infarction of a pituitary adenoma [1]
PA may be associated with an abnormal sphenoid sinus microbiota that is similar to that seen in patients with sphenoid sinusitis
In a recent study we noted that sphenoid sinus mucosal thickening (SSMT) was present in 62% of PA patients compared to just 6% of a control group of non-functioning pituitary adenomas (NFPAs) [2]
Summary
Pituitary apoplexy (PA) is an acute clinical syndrome secondary to haemorrhage and/or infarction of a pituitary adenoma [1]. Patients classically present with a sudden onset of headache, nausea/vomiting, visual disturbance and/or altered conscious level [1]. PA is presumed to be a spontaneous vascular event and risk factors include anticoagulant therapy, major surgery, dopamine agonist therapy, pregnancy and radiation therapy [1]. We and others have observed a high incidence of abnormal sphenoid sinus changes in PA [2]. In a recent study we noted that sphenoid sinus mucosal thickening (SSMT) was present in 62% of PA patients compared to just 6% of a control group of non-functioning pituitary adenomas (NFPAs) [2]. The aetiology of SSMT in PA is unknown and possibilities include inflammation or infection
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