ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 P407

Pituitary abscess: a case report

Andrzej Darczuk1, Malgorzata Trofimiuk1, Justyna Gil1, Alicja Hubalewska-Dydejczyk1, Wlodzimierz Mnich2 & Dariusz Adamek3

1Departament, Collegium Medicum, Jagiellonian University, Krakow, Poland; 2Neurosurgery and Neurotraumatology Departament, Collegium Medicum, Jagiellonian University, Krakow, Poland; 3Neuropathology Departament, Collegium Medicum, Jagiellonian University, Krakow, Poland.

Pituitary abscess is a very rare entity, only 200 cases (mostly the complication of the pituitary surgery) has been described so far.

We want to present the case of pituitary abscess arising from Rathke’s cyst.

Case report: Seventy-years-old female treated due to clinical depression, was admitted to the Endocrinology Department because of profound hyponatremia (serum Natrium 119 mmol/l). She was diagnosed with plurihormonal anterior pituitary insufficiency. After implementation of substitution with hydrocortisone and levothyroxin hyponatremia resolved. Pituitary MR revealed expansive tumor, hyperintensive on T2-weighted images, suggesting the Rathke’s cyst. Mild hyperprolactinaemia was attributed to the pituitary stalk compression by the tumour and the treatment with antidepressants. The patient was referred to the Neurosurgery Department, where the tumor was removed by the transsphenoidal approach. Histopathological evaluation revealed a cyst filled with non-specific granulation and fibrous tissue and planoepithelial metaplasia of the cyst wall. The tumour invaded the sphenoid sinus. The surgery was complicated by late cerebrospinal fluid leakage.

Conclusions: Pituitary tumor may be a difficult diagnostic dilemma, particularly in the absence of the general symptoms. Although sellar abscess is extremely rare, it may be suspected in patient with invasive cystic lesion in the pituitary. The correct diagnosis may be made only based on histopathological examination.

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