Justice O. Agyei, Lindsay J. Lipinski, Jody Leonardo

Pituitary abscess is a rare but potentially life-threatening condition with an incidence of 0.2-1.1% of operative pituitary lesions. Diagnosis can be challenging, as this disorder shares many similarities with other pituitary lesions in terms of symptomatology and radiographic findings. Most pituitary abscesses are categorized as secondary, arising from pre-existing pituitary lesions or in conjunction with transsphenoidal surgery, sepsis, meningitis, or sinusitis. To date, there have been only a handful of reports of primary pituitary abscess, which occurs without any of the aforementioned risk factors. We present a case of primary pituitary abscess in a 38-year-old woman with headaches, blurry vision, polyuria, and polydipsia who was found to have hypopituitarism. Brain magnetic resonance imaging demonstrated a sellar/suprasellar mass, which was endoscopically resected via a transsphenoidal approach. Egress of yellow-greenish creamy fluid was noted upon dural incision. The patient was treated with a 6-week course of antibiotic therapy postoperatively and had resolution of symptoms. A PubMed search was performed; all cases of pituitary abscess reported in the literature were screened, and 200 cases including our case were analyzed with a focus on outcomes. The most common presentations were headache, visual disturbance, and endocrine abnormalities. Approximately 66.1% of patients achieved partial or complete recovery of pituitary function; 75.7% with vision deficits recovered visual function. Treatment via a craniotomy had a recurrence rate of 17.2% compared to 9.7% via a transsphenoidal approach. To our knowledge, this is the first systematic review on the topic and the largest series reported.; Abbreviations: DI, diabetes insipidus, MR, magnetic resonance.