Al Salman Jameela Mohammed, Al Agha Rawan Al Muataz Billa, Helmy Mohamed
Medical Department, Salmaniya Medical Complex, Isa Town, Bahrain.
Department of Internal Medicine, Salmaniya Medical Complex, Manama, Bahrain.
BMJ Case Rep. 2017 Jun 8;2017:bcr-2016-217912. doi: 10.1136/bcr-2016-217912.
Pituitary abscess is an uncommon pituitary lesion. Its clinical diagnosis can be difficult to distinguish from other pituitary lesions. This pathology is characterised by vague symptoms of headaches, generalised tiredness and hypopituitarism manifestations. A history of recent meningitis, paranasal sinusitis or head surgery can be a suggestive of the source of infection.A 20-year-old man was admitted to neurosurgery department with complain of headache, fatigue, polyuria, polydipsia, blurred vision and sexual dysfunction. MRI of the head revealed a suprasellar mass that was centrally hyperintense lesion on T2-weighted images with peripheral hypointensity and isointense centrally on T1 images with peripheral hyperintensity images. Treatment of this lesion pituitary abscess was surgical drainage of the pituitary area through a trans-sphenoidal approach and broad spectrum antibiotic therapy with ceftriaxone, metronidazole and vancomycin for 6 weeks. The patient continues to have pituitary insufficiency and treated with oral hydrocortisone.Although pituitary abscess is a rare condition, it should always be kept in mind when evaluating a patient with hypopituitarism. After the diagnosis, the surgery and antibiotics should be commenced rapidly. The outcome is usually good with proper treatment.
垂体脓肿是一种罕见的垂体病变。其临床诊断可能难以与其他垂体病变相区分。这种病理表现为头痛、全身乏力和垂体功能减退等模糊症状。近期有脑膜炎、鼻窦炎或头部手术史可能提示感染源。一名20岁男性因头痛、疲劳、多尿、多饮、视力模糊和性功能障碍入住神经外科。头部MRI显示鞍上有一肿块，在T2加权图像上为中央高信号病变，周边低信号，在T1图像上中央等信号，周边高信号。该垂体脓肿病变的治疗是通过经蝶窦入路对垂体区域进行手术引流，并使用头孢曲松、甲硝唑和万古霉素进行6周的广谱抗生素治疗。患者仍有垂体功能不全，接受口服氢化可的松治疗。虽然垂体脓肿是一种罕见疾病，但在评估垂体功能减退患者时应始终予以考虑。诊断后，应迅速开始手术和使用抗生素治疗。经过适当治疗，预后通常良好。
