ESPE Abstracts

Background: Pituitary abscess is a rare disorder, representing less than 1% of pituitary lesions. Preoperative diagnosis is often difficult due to non-specific symptoms and image findings.

Case Report: Here, we report the case of a 10-year-old girl with a pituitary abscess. She presented with polyuria and polydipsia and headache for the past year. Magnetic resonance imaging revealed polycystic lesion in the sella turcica to suprasellar lesion, which extended to the pituitary stalk and compressed the optic chiasm. The lesion was hypointense on T1, and high intensity on T2, and peripheral rim enhancement following gadolinium injection. Computed Tomography showed no calcification. Laboratory test showed no elevation of C-reactive protein level. Hormonal evaluation revealed central diabetes insipidus, moderate growth hormone deficiency, hypogonadotropic hypogonadism, central hypothyroidism, and mild adrenal insufficiency. Thyroid hormone and antidiuretic hormone replacement initiated. Craniopharyngioma was initially suspected, and a transsphenoidal surgery was performed. Hydrocortisone was administered perioperatively. Intraoperatively, an abscess was seen and diagnosed as a pituitary abscess. Pathology did not reveal any neoplastic lesions. Culture of the abscess was negative. She was treated with antibiotics for 4 weeks after surgery; CTRX was used but was switched to MEPM during the course of the treatment because of a skin rash that was suspicious of drug eruption. Hypopituitarism persists after 4 weeks of antibiotic therapy and thyroid hormone and antidiuretic hormone replacement therapy is continued and growth hormone replacement was initiated.

Conclusion: Pituitary abscess are rare, especially in children, but should be differentiated when MRI show rim-enhancing pituitary mass even in the absence of signs of infection.