Diagnosis and management of pituitary abscess

ABSTRACT

Pituitary abscess is a rare but serious intrasellar infection. To determine the signs and symptoms we present one case of a 40 year-old man without an infectious history nor of immunodepression, who had complained of severe headache, a right converge strablism, polyuria and polydipsia. The neurological examination was normal investigation of the old site was negative. Computerised tomography showed a pituitary adenoma. Magnetic resonance imaging [MRI] on the other hand, was in favour of a pituitary abscess sellar hypointense T1-weighted, hyper-signal T2-weighted lesion with thin ring-enhancement following gadolinium injection. Transsphenoidal surgery was performed with a sterile culture. Anatomo-pathological study of the capsule showed nonspecific inflammatory tissue. Under antibiotherapy and after three months of clinical improvement, the symptomatology reappeared with a recurrence of the pituitary abscess on MRI. Drainage was carried out in the same manner as initially. Evolution under the same antibiotherapy was good with no recurrence of the pituitary abscess three years later. Pituitary abscess is a rare pathology, of difficult diagnosis even with MRI and often presents a surprise whilst operating. Outcome, except in recurrence, is excellent