Endoscopic transsphenoidal surgery for the treatment of pituitary abscess: four cases reports and literature review

Abstract

Objective To report 4 patients with pituitary abscess (PA), and summarize etiology, clinical manifestation, imaging, endocrinological characteristics, treatment and prognosis of PA in combination with literatures review. Methods and Results Four patients (3 cases were primary PA, one case was secondary PA) from January 2015 to August 2019 were included in the study during 534 cases whose sellar region lesion were diagnosed. The main clinical manifestations were headache (4 cases), blurred vision and temporal blindness (4 cases), fatigue and anorexia (4 cases), polyuria (2 cases) and transient hyperthermia (2 cases). MRI showed cystic occupying lesions in the sellar region, with typical enhancement in the cystic wall (4 cases). Endocrinology showed hypothyroidism (4 cases), hypoadrenocorticism (3 cases) and hypogonadism (3 cases). After hormone replacement therapy (HRT) and antibiotic anti ⁃ infection treatment, endoscopic transsphenoidal removal of PA was adopted. The clinical symptoms gradually improved. Pituitary function in 3 cases returned to normal, one case still needed HRT. MRI showed no sign of recurrence of PA. Conclusions Early symptoms in PA is prone to hypopituitarism. PA is characterized by edge⁃enhanced cystic space⁃occupying lesion in MRI. Endoscopic transsphenoidal removal of PA is the fine ⁃ line treatment and the prognosis is good while the patients' recurrence rate is low. DOI：10.3969/j.issn.1672⁃6731.2020.03.012

Keywords

• brain abscess
• pituitary gland
• sphenoid sinus
• neurosurgical procedures
• prognosis