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Endocrine Abstracts (2014) 35 S7.2 | DOI: 10.1530/endoabs.35.S7.2

Department of Neuroendocrinology, Clinic for Endocrinology, Diabetes and Metabolic Disorders, University Clinical Center, Belgrade, Serbia.


The first case of pituitary abscess was described a 100 years ago and since then, only a few 100 cases have been reported in the literature, mainly as case reports. Bacterial infections are the most common etiology, while tuberculosis, viral, fungal, and parasitic infections occur much less frequently. Pituitary infections may be primary or secondary and may develop due to hematogenous seeding or by direct extension of adjacent infections (sphenoid sinusitis, cavernous sinus thrombophlebitis, meningitis, or following tooth extraction). Risk factors for pituitary infections include immunocompromised conditions and previous pituitary surgery or irradiation. However, cases have also reported in immunocompetent patients. We will present progression of allergic fungal sinusitis (chronic inflammatory infiltrate comprised of extracellular mucin and fungal hyphae) from the sphenoid sinus to the sellar region in an immunocompetent patient. The presence of a sellar mass with suprasellar extension may be misinterpreted as pituitary macroadenoma. Endocrine symptoms may include partial or total hypopituitarism, central diabetes insipidus and hyperprolactinemia. Neurological symptoms include headache, visual disturbance, signs of meningism, cranial neuropathy and mental changes. Radiological findings of pituitary infections sometimes are difficult to distinguish from pituitary neoplasms. Due to the lack of specific clinical and radiological presentations, most patients are diagnosed only after surgery or at the time of autopsy. Hypopituitarism may develop as an acute or late consequence of pituitary infection. We will present the late sequaele of viral hypophysitis caused by Hantaan virus infection (hemorrhagic fever with renal syndrome), hypopituitarism with empty sella. In conclusion, pituitary infections should be considered in the differential diagnosis of sellar lesions and in particular as underlying pathological diagnosis of hypopituitarism.

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