Endocrine Abstracts

JOINT1770

We present a case of a 39-year-old immunocompetent woman who developed a purulent pituitary infection, most likely secondary to recurrent sinusitis, that led to anterior pituitary insufficiency and vasopressin deficiency (AVP-D). The first symptoms appeared nine months postpartum and included severe headaches, vomiting, secondary amenorrhea, polydipsia, and polyuria. Multi-hormonal pituitary insufficiency and AVP-D were diagnosed. Pituitary MRI revealed an enlarged pituitary gland with a well-demarcated solid-cystic lesion measuring 22×14×16 mm, causing expansion of the sella turcica. Due to the suspicion of a pituitary adenoma, the patient underwent transsphenoidal surgery. During the procedure, upon incision of the lesion’s capsule, thick yellow purulent-like content was released. Histopathological examination revealed features of chronic inflammatory exacerbation with necrosis, likely originating from the abscess wall. However, the patient did not receive further treatment apart from hormone replacement, owing to no improvement in pituitary function. She was admitted to our Department a year after an initial surgery due to gradually worsening symptoms, including headaches, nasal obstruction, and olfactory disturbances. MRI revealed an extensive infiltration involving the enlarged pituitary gland and sphenoid sinus. Due to symptomatic progression a second transsphenoidal surgery was performed. Histopathological analysis again revealed an inflammatory infiltrate, and Staphylococcus aureus was cultured from the sample. Targeted antibiotic therapy was initiated. Follow-up MRI scans showed no recurrence of the focal lesion. Based on clinical presentation, MRI findings, and histopathological and microbiological results, a diagnosis of pituitary abscess, leading to permanent multi-hormonal pituitary insufficiency and AVP-D, was established.

Discussion: Pituitary inflammation is a rare disease. The most common type is lymphocytic hypophysitis, while bacterial pituitary infections are exceedingly rare. The most frequently reported symptoms include headache, vomiting, visual disturbances, and signs of anterior or posterior pituitary insufficiency. MRI imaging typically shows a symmetrically enlarged gland with homogeneous contrast enhancement. Additionally, the characteristic "bright spot" of the neurohypophysis in T1-weighted images is usually absent, and the pituitary stalk may appear thickened. In some cases, the MRI appearance may resemble a pituitary adenoma or cyst. The treatment of choice for autoimmune-related hypophysitis in patients with neurological symptoms (e.g., severe headaches, cranial nerve palsies, and visual disturbances) is high-dose glucocorticoid therapy. However, other etiologies, such as infectious causes—like in the presented patient—should also be considered, and treatment should be tailored accordingly. In bacterial pituitary infections, obtaining cultures and an antibiotic susceptibility profile is crucial for implementing targeted antibiotic therapy.