Masa selar, no siempre un adenoma: presentación de 3 casos clínicos / A sellar mass, not always an adenoma: A report of 3 cases

El absceso hipofisario es un proceso infeccioso dentro de la silla turca, infrecuente, grave y de difícil diagnóstico debido a sintomatología variada e inespecífica. Presentamos 3 casos clínicos de abscesos hipofisarios, teniendo en común la presencia de lesiones preexistentes. Todos fueron intervenidos quirúrgicamente, 2 pacientes resultaron ser abscesos asépticos y en un paciente se aisló Aspergillus capsulatum. Presentaron buena evolución con el tratamiento médico pero con secuelas de hipopituitarismo. Es muy importante tener en cuenta el absceso hipofisario entre los diagnósticos diferenciales de las masas que se localicen en esa región debido a que el diagnóstico oportuno y el tratamiento correcto son relevantes para el pronóstico de estos pacientes.

Pituitary abscess is due to a severe and uncommon infection in the sella. It is difficult to diagnose due to varied and non-specific symptoms. A report is presented of 3 cases of pituitary abscess, which had the presence of pre-existing injuries in common. All were subjected to surgery, with aseptic abscesses found in 2 patients, and Aspergillus capsulatum was isolated in 1 patient. They showed good progress with medical treatment, but with sequelae of hypopituitarism. It is very important to consider the pituitary abscess in the differential diagnosis of the masses that are located in that region, as a timely diagnosis and proper treatment can be important for the prognosis of these patients.

Invasive aspergillosis of pituitary gland in an immunocompetent patient

Invasive aspergillosis is a major cause of morbidity and mortality in immunosuppressed patients. This infection is caused by Aspergillus, a hyaline mold, which is the etiologic agent for many different manifestations. A 63 year old diabetic housewife woman, living in northern Iran, presented with the history of right eye ptosis after a mild head trauma since about 3 weeks ago. She had positive history of intermittent headache several weeks before ptosis. On physical examination, the patient was afebrile and other vital signs were normal. Brain MRI showed a pituitary mass measuring about 4 cm. Pathological study showed hyphae in favor of aspergillosis. Amphotericin B was started and after 10 days changed to itraconazole. It is important to consider fungal infection as a differential diagnosis of cerebral lesions even in the immunocompetent hosts. The clinical presentation of cerebral aspergillosis is nonspecific and is characterized by focal neurologic signs, alteration in mental status and headache