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Jang, Yun, Shin, Kim, Lim, Cho, Yoon, Kang, Cha, Son, and Hong: A Case of Pituitary Abscess that was Difficult to Diagnose due to Repeated Symptomatic Responses to Every Corticosteroid Administration
Case Report
Endocrinology and Metabolism

Endocrinology and Metabolism 2011; 26(1): 72-77.

Published online: 31 March 2011

DOI: https://doi.org/10.3803/EnM.2011.26.1.72

A Case of Pituitary Abscess that was Difficult to Diagnose due to Repeated Symptomatic Responses to Every Corticosteroid Administration

Jin Sun Jang, Jae Seung Yun, Jung Ah Shin, Min Hee Kim, Dong Jun Lim, Jae Hyung Cho, Kun Ho Yoon, Moo Il Kang, Bong Yun Cha, Ho Young Son, Yong Kil Hong1

Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

1Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Corresponding author: Dong Jun Lim. Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-6009, Fax: +82-2-599-3589, ldj6026@catholic.ac.kr

Received 3 June 2010       Accepted 10 August 2010

Copyright © 2011 Korean Endocrine Society

Abstract

Pituitary abscess is a rare pathology, but it is a potentially life-threatening condition. Therefore, timely intervention, including antibiotics and an operation, can prevent the morbidity and mortality in such cases. A 31-year-old woman, who was 16 months after her second delivery, presented with intermittent headache for 3 months. Amenorrhea, polyuria and polydipsia were noticed and the endocrinological hormone studies were compatible with panhypopituitarism and diabetes insipidus. Pituitary MRI demonstrated a 2.3 cm sized cystic mass with an upper small nodular lesion. Her symptoms such as headache and fever were repeatedly improved whenever corticosteroid was administered, which led us to suspect the diagnosis of an inflammatory condition like lymphocytic hypophysitis. During the hormone replacement therapy, her cystic pituitary mass had grown and her symptoms progressively worsened for another two months. The patient underwent trans-sphenoidal exploration and she turned out to have a pituitary abscess. At the 3-month follow-up, amenorrhea was noticed and her residual function of the pituitary was tested by a combined pituitary stimulation test. The results were compatible with panhypopituitarism. She received levothyroxine 100 µg, prednisolone 5 mg and desmopressin spray and she is being observed at the out-patient clinic. The authors experienced a patient with primary pituitary abscess that was confirmed pathologically and we report on its clinical course with a literature review.

Keywords: Corticosteroids, Panhypopituitarism, Pituitary abscess

Figures and Tables

Fig. 1
Sella MRI; upper panels, T1-weighted images; lower panels, enhanced T1-weighted images. Initial sagittal images (A, D) show a 1.4 × 2.3 × 2.2 cm sized cystic mass (thin arrow) in sellar and suprasellar region with thickened stalk and a 1.4 cm sized enhancing nodular lesion (thick arrow) above the mass. 2 months later, preoperative sagittal images (B, E) show significant increase in size, extent and signal intensity of the cystic mass (thin arrow) and nodular contrast-enhancing lesion (thick arrow) on upper margin of the mass. Post-operative images (C, F) show that pituitary abscess was completely removed and normal pituitary gland was remaining with enhancement by gadolinium, along with pituitary stalk.
enm-26-72-g001
Fig. 2
Histology of the pituitary abscess. A, B. Polymorphonuclear neutrophil and fibrous tissue showing mild acute and chronic inflammation with focal necrosis and calcification (H&E staining, A, × 40, B, × 200).
enm-26-72-g002
Table 1
Combined pituitary stimulation test at initial presentation and 3 months following surgery (insulin intolerance test, TRH, GnRH)
enm-26-72-i001

TRH, thyrotropin releasing hormone; GnRH, gonadotropin releasing hormone; ACTH, adrenocorticotrophic hormone; TSH, thyroid stimulating hormone; LH, luteinizing hormone; FSH, follicle stimulating hormone; GH, growth hormone.

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