ro13-9904 and Pituitary-Diseases

Only 20 cases of abscess formation within a Rathke cleft cyst have been reported.. Case report and review of the English-language literature.. A 64-year-old female was admitted with a 12-mo history of headache and decreased visual acuity and had bilateral papilledema and bitemporal hemianopsia with impairment of visual acuity. Magnetic resonance imaging demonstrated a sellar and suprasellar mass measuring 2×2×2 cm. The lesion was removed using a transsphenoidal approach. The abscess was drained, and gram stain revealed polymorphonuclear cells and gram-positive cocci. The postoperative course was uneventful. Ceftriaxone and metronidazole were continued for 6 wks. The patient also received hydrocortisone and continued thyroid hormone replacement. During a 6-mo follow up, the patient's headaches disappeared, and the bitemporal hemianopsia and impaired visual acuity abated.. Predisposing factors for pituitary abscesses in primary lesions include immunosuppression and pituitary irradiation, surgery, or infarction. Approximately one-third of pituitary abscesses arise within other lesions. The clinical manifestations are non-specific. Magnetic resonance imaging shows a cystic lesion with central low intensity and rim enhancement after administration of contrast. When a pituitary abscess is diagnosed, surgical procedures should be performed promptly via a transsphenoidal (preferably) or transcranial approach.

Topics: Anti-Infective Agents; Brain; Brain Abscess; Ceftriaxone; Central Nervous System Cysts; Debridement; Drainage; Female; Humans; Magnetic Resonance Imaging; Metronidazole; Middle Aged; Pituitary Diseases; Radiography

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.

Topics: Anti-Bacterial Agents; Antiprotozoal Agents; Brain Abscess; Ceftriaxone; Diagnosis, Differential; Humans; Hydrocortisone; Hypopituitarism; Magnetic Resonance Imaging; Male; Metronidazole; Pituitary Diseases; Pituitary Gland; Treatment Outcome; Vancomycin; Young Adult

Topics: Acute Disease; Administration, Inhalation; Adult; Asthma; Brain Abscess; Ceftriaxone; Cocaine-Related Disorders; Diagnosis, Differential; Drainage; Drug Therapy, Combination; Female; Headache; Humans; Magnetic Resonance Imaging; Meningitis, Escherichia coli; Nasal Septal Perforation; Photophobia; Pituitary Diseases; Pituitary Neoplasms; Vancomycin