Sato M, Matsushima Y, Taguchi J, Matsumoto S, Tatsumi C, Ozaki M, Hanada M, Hayakawa T
Department of Neurosurgery, Toyonaka Municipal Hospital.
No Shinkei Geka. 1995 Nov;23(11):991-5.
Pituitary abscess is relatively rare. Only about 80 cases have been reported. Preexisting lesions in pituitary fossa, such as pituitary adenoma, craniopharyngioma and Rathke's cleft cyst, are inclined to be complicated by infection more than the normal pituitary glands are. We reported a case of pituitary abscess caused by infection of Rathke's cleft cyst. A 67-year-old male had general fatigue and loss of appetite 4 months before admission. On admission he was found to have diabetes mellitus, diabetes insipidus, and hypernatremia. These defects were controlled by medication but he gradually became comatose and febrile. CT and MRI revealed an intrasellar lesion with ring enhancement. Lumbar puncture demonstrated an increase of mononuclear cells and protein. Blood chemistry revealed a marked increase of CRP. He was operated on via the transsphenoidal approach, which revealed sphenoid sinusitis and abscess formation in the pituitary gland. Histological examination of the surgical specimen revealed infection of Rathke's cleft cyst but the fluid in the cyst was sterile. By the drainage of the cyst and the use of antibiotics the patient became alert and signs of infection disappeared. He was discharged with a slight hypopituitarism and returned to normal life. Mortality rate of pituitary abscess is decreasing but is still high because of hypopituitarism and severe infection. Accurate diagnosis and operation are necessary. Transsphenoidal surgery is preferable for postoperative drainage of the abscess.
垂体脓肿相对少见。仅约80例病例有报道。垂体窝内的原有病变，如垂体腺瘤、颅咽管瘤和拉克氏囊肿，比正常垂体更易发生感染并发症。我们报告了1例由拉克氏囊肿感染引起的垂体脓肿病例。一名67岁男性在入院前4个月出现全身乏力和食欲减退。入院时发现他患有糖尿病、尿崩症和高钠血症。这些病症通过药物得到控制，但他逐渐昏迷并发热。CT和MRI显示鞍内病变有环状强化。腰椎穿刺显示单核细胞和蛋白质增加。血液化学检查显示CRP显著升高。他接受了经蝶窦入路手术，术中发现蝶窦炎和垂体脓肿形成。手术标本的组织学检查显示拉克氏囊肿感染，但囊肿内液体无菌。通过囊肿引流和使用抗生素，患者意识恢复清醒，感染迹象消失。他出院时伴有轻度垂体功能减退，恢复了正常生活。垂体脓肿的死亡率正在下降，但由于垂体功能减退和严重感染，死亡率仍然很高。准确的诊断和手术是必要的。经蝶窦手术对于术后脓肿引流更为可取。
