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Pituitary abscess: clinical manifestations, diagnosis and treatment of 66 cases from a large pituitary center over 23 years.
Pituitary. 2017 Apr; 20(2):189-194.P

Abstract

PURPOSE

Pituitary abscess (PA) is rare and commonly described in case reports or small case series. This study aimed to better determine salient clinical manifestations related to the diagnosis and appropriate treatment of PA using by far the largest case series of this disease.

METHODS

A total of 6361 consecutive patients underwent surgery for pituitary diseases in Peking Union Medical College Hospital between January 1991 and December 2013. Among this cohort, sixty-six patients were diagnosed with PA based on both intraoperative findings and postoperative histopathological evidence.

RESULTS

The most common clinical presentation was anterior pituitary hypofunction (81.8 %), followed by common headache (69.7 %), diabetes insipidus (DI; 47.9 %), visual disturbances (45.5 %) and symptoms related to infection (43.9 %). Forty patients (66.7 %) showed typical rim enhancement after gadolinium injection on magnetic resonance imaging (MRI). Most patients (63 of 66, 95.5 %) underwent transsphenoidal surgery (TSS), and the remaining 3 patients (4.5 %) were treated with transcranial surgery (TC). After follow-up for 7.2 ± 4.9 years, PA was diminished in most patients (81.8 %), as demonstrated by post-operative MRI, and eight patients underwent at least one additional operation due to recurrence.

CONCLUSIONS

For patients with hypopituitarism and DI with rim enhancement on MRI, we should consider the possible diagnosis of PA. Proper use of antibiotics, complete drainage via surgery and hormone replacement for hypopituitarism are the key treatments for PA.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Gao L
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China. China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
Guo X
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China. China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
Tian R
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China. China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
Wang Q
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China. China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
Feng M
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China. China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
Bao X
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China. China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
Deng K
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China. China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
Yao Y
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China. China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
Lian W
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China. China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
Wang R
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China. China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China.
Xing B
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China. xingbingemail@aliyun.com. China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, 100730, China. xingbingemail@aliyun.com.

MeSH

AdultAgedBrain AbscessFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedNeurosurgical ProceduresPituitary DiseasesRetrospective Studies

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27696121

Citation

Gao, Lu, et al. "Pituitary Abscess: Clinical Manifestations, Diagnosis and Treatment of 66 Cases From a Large Pituitary Center Over 23 Years." Pituitary, vol. 20, no. 2, 2017, pp. 189-194.
Gao L, Guo X, Tian R, et al. Pituitary abscess: clinical manifestations, diagnosis and treatment of 66 cases from a large pituitary center over 23 years. Pituitary. 2017;20(2):189-194.
Gao, L., Guo, X., Tian, R., Wang, Q., Feng, M., Bao, X., Deng, K., Yao, Y., Lian, W., Wang, R., & Xing, B. (2017). Pituitary abscess: clinical manifestations, diagnosis and treatment of 66 cases from a large pituitary center over 23 years. Pituitary, 20(2), 189-194. https://doi.org/10.1007/s11102-016-0757-7
Gao L, et al. Pituitary Abscess: Clinical Manifestations, Diagnosis and Treatment of 66 Cases From a Large Pituitary Center Over 23 Years. Pituitary. 2017;20(2):189-194. PubMed PMID: 27696121.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pituitary abscess: clinical manifestations, diagnosis and treatment of 66 cases from a large pituitary center over 23 years. AU - Gao,Lu, AU - Guo,Xiaopeng, AU - Tian,Rui, AU - Wang,Qiang, AU - Feng,Ming, AU - Bao,Xinjie, AU - Deng,Kan, AU - Yao,Yong, AU - Lian,Wei, AU - Wang,Renzhi, AU - Xing,Bing, PY - 2016/10/4/pubmed PY - 2017/7/14/medline PY - 2016/10/4/entrez KW - Diagnosis KW - Pituitary abscess KW - Transsphenoidal surgery KW - Treatment SP - 189 EP - 194 JF - Pituitary JO - Pituitary VL - 20 IS - 2 N2 - PURPOSE: Pituitary abscess (PA) is rare and commonly described in case reports or small case series. This study aimed to better determine salient clinical manifestations related to the diagnosis and appropriate treatment of PA using by far the largest case series of this disease. METHODS: A total of 6361 consecutive patients underwent surgery for pituitary diseases in Peking Union Medical College Hospital between January 1991 and December 2013. Among this cohort, sixty-six patients were diagnosed with PA based on both intraoperative findings and postoperative histopathological evidence. RESULTS: The most common clinical presentation was anterior pituitary hypofunction (81.8 %), followed by common headache (69.7 %), diabetes insipidus (DI; 47.9 %), visual disturbances (45.5 %) and symptoms related to infection (43.9 %). Forty patients (66.7 %) showed typical rim enhancement after gadolinium injection on magnetic resonance imaging (MRI). Most patients (63 of 66, 95.5 %) underwent transsphenoidal surgery (TSS), and the remaining 3 patients (4.5 %) were treated with transcranial surgery (TC). After follow-up for 7.2 ± 4.9 years, PA was diminished in most patients (81.8 %), as demonstrated by post-operative MRI, and eight patients underwent at least one additional operation due to recurrence. CONCLUSIONS: For patients with hypopituitarism and DI with rim enhancement on MRI, we should consider the possible diagnosis of PA. Proper use of antibiotics, complete drainage via surgery and hormone replacement for hypopituitarism are the key treatments for PA. SN - 1573-7403 UR - https://www.unboundmedicine.com/medline/citation/27696121/Pituitary_abscess:_clinical_manifestations_diagnosis_and_treatment_of_66_cases_from_a_large_pituitary_center_over_23_years_ DB - PRIME DP - Unbound Medicine ER -