Endocrine Abstracts

Introduction: Pituitary abscess (PA) is a rare accounting for 0,2-1% of all sellar lesions, it is generally classified as primary or secondary according to their etiopathogenesis.

Case: A 20-year-old female with a history of vulvitis a year ago, dental abscesses on multiple dental caries who presented 05 months ago with intracranial hypertension syndrome in a febrile context. One-month later amenorrhea sets in as well as polyuropolydeptic syndrome, hormonal exploration reveals panhypopituitarism and the MRI showed a pituitary abscess measuring 13×14 mm extended to a height of 10 mm presenting in discrete T1 hyposignal, T2 hypersignal and diffusion with clear drop in ADC, enhancing in an annular and peripheral manner after injection of gadolinium salts, the patient was treated with double antibiotics therapy for 21 days without success as well as dental care. The abscess disappears spontaneously after 8 months of evolution.

Discussion: Primary PA represent the most common type, accounting for 67% of all cases so far reported and result from hematogenous bacterial spread to an otherwise normal pituitary gland. On the contrary, secondary PA occur in only 33% of cases and represent a secondary infection of pre-existing sellar lesions. In those cases of secondary PA, factors such as the anatomical distortion and subsequently impaired circulation, as well as the altered immunological status may be considered a pre-existing condition for abscess formation. On the contrary, due to the limited number of cases so far reported and their heterogenous management, little is known about the risk factors and natural history typical of primary PA. PA pathophysiology is still unknown for both primary and secondary PAs, even though several hypotheses have been considered. Atlas et al. reported that either primary or secondary PA could be the result of both hematogenous seeding or direct extension from an adjacent infectious process, as in cases of sphenoid sinusitis, meningitis, or contamination from a CSF fistula. Vates et al., in their series, reported that 16.7% of patients had a history of sepsis, Charles-Henry Mallereau et al. reported only 4 of 84 patients with a medical history of dental granuloma that could potentially be considered as the primary infectious focus. Other risk factors considered included an underlying immune-compromised condition and previous radiotherapy

Conclusion: Despite highly sophisticated clinical and radiological investigations, the preoperative diagnosis of PA remains challenging and recently led to the proposal for a management algorithm for sellar masses suspected for being PA.