Endocrine Abstracts

We report the case of a 57-year-old woman who presented with headache of sudden onset and with blurring of vision in the right eye. This had been preceded by a week's history of fever, rigors and coryzal symptoms which had been treated as malaria and had subsequently settled. Examination demonstrated proptosis and complete ophthalmoplegia of the right eye with 6/60 acuity. Baseline investigations included normal urea and electrolytes, clotting screen and full blood count, with a white cell count of 7.5 x 10⁹/l. Two successive computerised tomography brain scans failed to disclose an abnormality. Magnetic resonance imaging using T1-weighted post-gadolinium sequences showed a large, ring-enhancing pituitary mass which was compressing the optic chiasm and invading the right cavernous sinus. In addition there was right sphenoid sinusitis with mucosal thickening. The patient underwent expedient trans-sphenoidal decompression of the pituitary gland. Pus within the fossa grew staphylococcus epidermidis and the tumour beyond was demonstrated to be chromophobe pituitary adenoma with negative immunostaining.

Post-operatively the patient received intravenous antibiotics for a week. She was discharged 10 days after surgery on standard hydrocortisone and thyroxine replacement, made a good recovery, and, at three month follow-up, her eye movements and visual fields had returned to normal.

Pituitary abscess is a relatively uncommon condition which should be treated by prompt surgical decompression followed by appropriate antimicrobial therapy and pituitary hormone replacement, with careful follow-up to exclude regrowth of tumour or abscess. The particular conclusion to be drawn from this case is that ring enhancement on pituitary scans indicates the possibility of abscess formation, even in the absence of pyrexia or leucocytosis.