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Pituitary abscess presenting with cranial nerve paresis. Case report and review of literature.
J Endocrinol Invest. 2001 Jan; 24(1):45-50.JE

Abstract

Non-adenomatosus lesions of the pituitary represent a small part of the intrasellar processes and they have heterogeneous presentation. Making a precise diagnosis is of great importance, as it may lead to more efficient management. A 65-year-old man was admitted to the hospital because of headache and right cranial nerve III palsy. Basic laboratory work-up was normal whereas endocrinological assessment revealed hypopituitarism without diabetes insipidus. Plain radiography showed an enlarged sella and frontal and paranasal sinusitis. Computed tomography (CT) and magnetic resonance imaging (MRI) of the sella revealed an intrasellar lesion with extension to the sphenoid and cavernous sinuses as well as the suprasellar region, exerting pressure on the optic chiasm. On T1-weighted images the mass had a low-intensity signal with a smooth enhancing rim with bright signal. Given the presence of multiple sinusitis and imaging characteristics a pre-operative diagnosis of pituitary abscess was made. The patient was operated via transphenoidal route and purulent material was drained out. Cultures of the material were positive for Staphylococcus aureus. Antibiotics as well as cortisol replacement therapy were given. Three months later hypopituitarism persisted but there was significant improvement in the neurological findings. We report a case of an unusual presentation of a pituitary abscess. High index of suspicion, the presence of associated conditions such as pituitary tumors, meningitis or sinusitis, as well as diabetes insipidus and specific imaging features are the main diagnostic clues. Pre-operative diagnosis, which will lead to prompt antibiotic therapy and transphenoidal drainage, can decrease high mortality and morbidity associated with this disease.

Authors+Show Affiliations

Somali MH
Department of Endocrinology, General Hospital Hippocration, Thessaloniki, Greece.
Anastasiou AL
No affiliation info available
Goulis DG
No affiliation info available
Polyzoides C
No affiliation info available
Avramides A
No affiliation info available

MeSH

AbscessAgedAnti-Bacterial AgentsCranial Nerve DiseasesDrainageHumansHydrocortisoneMaleParesisPituitary DiseasesStaphylococcal InfectionsTomography, X-Ray Computed

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

11227732

Citation

Somali, M H., et al. "Pituitary Abscess Presenting With Cranial Nerve Paresis. Case Report and Review of Literature." Journal of Endocrinological Investigation, vol. 24, no. 1, 2001, pp. 45-50.
Somali MH, Anastasiou AL, Goulis DG, et al. Pituitary abscess presenting with cranial nerve paresis. Case report and review of literature. J Endocrinol Invest. 2001;24(1):45-50.
Somali, M. H., Anastasiou, A. L., Goulis, D. G., Polyzoides, C., & Avramides, A. (2001). Pituitary abscess presenting with cranial nerve paresis. Case report and review of literature. Journal of Endocrinological Investigation, 24(1), 45-50.
Somali MH, et al. Pituitary Abscess Presenting With Cranial Nerve Paresis. Case Report and Review of Literature. J Endocrinol Invest. 2001;24(1):45-50. PubMed PMID: 11227732.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pituitary abscess presenting with cranial nerve paresis. Case report and review of literature. AU - Somali,M H, AU - Anastasiou,A L, AU - Goulis,D G, AU - Polyzoides,C, AU - Avramides,A, PY - 2001/3/3/pubmed PY - 2001/5/26/medline PY - 2001/3/3/entrez SP - 45 EP - 50 JF - Journal of endocrinological investigation JO - J Endocrinol Invest VL - 24 IS - 1 N2 - Non-adenomatosus lesions of the pituitary represent a small part of the intrasellar processes and they have heterogeneous presentation. Making a precise diagnosis is of great importance, as it may lead to more efficient management. A 65-year-old man was admitted to the hospital because of headache and right cranial nerve III palsy. Basic laboratory work-up was normal whereas endocrinological assessment revealed hypopituitarism without diabetes insipidus. Plain radiography showed an enlarged sella and frontal and paranasal sinusitis. Computed tomography (CT) and magnetic resonance imaging (MRI) of the sella revealed an intrasellar lesion with extension to the sphenoid and cavernous sinuses as well as the suprasellar region, exerting pressure on the optic chiasm. On T1-weighted images the mass had a low-intensity signal with a smooth enhancing rim with bright signal. Given the presence of multiple sinusitis and imaging characteristics a pre-operative diagnosis of pituitary abscess was made. The patient was operated via transphenoidal route and purulent material was drained out. Cultures of the material were positive for Staphylococcus aureus. Antibiotics as well as cortisol replacement therapy were given. Three months later hypopituitarism persisted but there was significant improvement in the neurological findings. We report a case of an unusual presentation of a pituitary abscess. High index of suspicion, the presence of associated conditions such as pituitary tumors, meningitis or sinusitis, as well as diabetes insipidus and specific imaging features are the main diagnostic clues. Pre-operative diagnosis, which will lead to prompt antibiotic therapy and transphenoidal drainage, can decrease high mortality and morbidity associated with this disease. SN - 0391-4097 UR - https://www.unboundmedicine.com/medline/citation/11227732/Pituitary_abscess_presenting_with_cranial_nerve_paresis__Case_report_and_review_of_literature_ DB - PRIME DP - Unbound Medicine ER -