Introduction: The most frequent clinical manifestations of pituitary macroadenoma include headache, vision disturbances and cranial nerve paralysis.
Case study: Thirty-year-old man was admitted to intensive care unit at regional hospital. On admission, he was unconscious, with convulsions, spasms and 3-day long history of headache as well as body temperature up to 41.5 °C. The patient was transferred to the Department of Infectious Diseases, with the suspicion of neuroinfection. MRI findings suggested the presence of pituitary abscess and extensive pathological lesion with the size of 27×28×38 mm with intensive marginal contrast enhancement, located in the sellar-suprasellar region. The lesion protruded into the sphenoid sinus through lowered Turkish saddle. Fluid content was also found in the sphenoid sinus. After 10 days of antibiotic therapy, the patient was transferred to neurosurgery ward for surgical treatment. Partial evacuation of pathological lesion was performed during right frontotemporal craniotomy. Patients general condition following the surgery was moderately severe; the patient was conscious and able to react to simple instructions, he had left paresis affecting particularly left lower limb and he also experienced speech disturbances. Signs of hypopituitarism in all hormone axes were found and the patient was referred to the Department of Endocrinology at Pomeranian Medical University for further treatment. Follow-up MRI showed persistent pathologic mass in the sellar-suprasellar region, which penetrated sphenoid sinus through destroyed saddle floor. Once hormone deficiency has been corrected and the patient completed several weeks of antibiotic therapy, he was transferred to the Department of Neurosurgery at Pomeranian Medical University for further surgical treatment. Transspehnoidal resection of sellar-suprasellar tumour and sphenoid sinuplasty were performed. Histopathologic findings confirmed the diagnosis of pituitary adenoma. The patient was referred to rehabilitation unit. One year later, check-up MRI showed deepened Turkish saddle filled with a mass corresponding to post-operative material. There was no evidence of recurrent proliferation process.