Permanent panhypopituitarism is a rare complication of acute bacterial sinusitis
A. Lavan, M. Hannon, M. OBrien & C. Thompson
Permanent pan-anterior hypopituitarism is a rare complication of bacterial sinusitis, with only six cases reported worldwide. However, all were reported before the advent of MR imaging and most did not have what is now regarded as gold standard evaluation of pituitary function. Also, all previous cases noted an interval of months between resolution of sinusitis and development of hypopituitarism. We report two cases of previously healthy Caucasian adults who developed pan-anterior hypopituitarism immediately following acute severe bacterial sinusitis.
The first patient presented with a 2 week history of frontal headache, sinus pain and fever and a three day history of right periorbital oedema. Clinical examination revealed partial bilateral third cranial nerve palsy, right sided sixth cranial nerve palsy and bilateral palsy of the ophthalmic branch of the trigeminal nerve. CT and MR brain scanning showed severe maxillary, sphenoid and ethmoid sinusitis. MR venogram showed no cavernous sinus thrombosis. The patient had endoscopic sphenoidotomy with decompression. There was no intraoperative hypotension. Histology revealed inflammatory disease. Following discharge he felt constantly fatigued, had reduced libido and facial hair growth. An insulin tolerance test was performed indicating pan-anterior hypopituitarism. He had no symptoms of diabetes insipidus. Repeat MR scanning revealed an atrophic pituitary gland.
The second patient had a long history of chronic sinusitis. MR scanning was performed to evaluate the sinuses and brain; this revealed a 1.5 cm mass in the pituitary fossa which was thought represent a pituitary macroadenoma. No focal neurological signs were present. Trans-sphenoidal surgery was performed which revealed pus in the pituitary fossa, biopsy was performed which revealed chronic inflammatory changes on histology. Again, there was no intraoperative hypotension. Post operative insulin tolerance testing revealed pan-anterior hypopituitarism. Diabetes insipidus was not present.
Pananterior hypopituitarism is a rare complication of severe sinusitis, which should be remembered if no response is seen to standard antibiotic treatment.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.