Primary pituitary abscess in an adolescent female patient: case report, literature review, and operative video

• Published in: Child's nervous system Vol. 37; no. 5; pp. 1423 - 1428
• Main Authors: Sherrod, Brandon A., Makarenko, Serge, Iyer, Rajiv R., Eli, Ilyas, Kestle, John R., Couldwell, William T.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2021
• Subjects: Adolescent; Brain Abscess - diagnostic imaging; Brain Abscess - drug therapy; Brain Abscess - surgery; Case-Based Review; Child; Drainage; Endoscopy; Female; Humans; Magnetic Resonance Imaging; Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Pituitary Diseases - diagnostic imaging; Pituitary Diseases - surgery; Infection; Pediatric; Pituitary; Abscess; Cutibacterium acnes
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-021-05052-8

Purpose Primary pituitary abscesses are extraordinarily rare lesions, especially in pediatric populations, with very few cases described in the literature. Here we review this rare condition and discuss its management. Methods We report a case of a previously healthy 12-year-old female patient who presented with vomiting and meningismus. We review the literature on pediatric patients presenting with pituitary abscesses and the described treatments. An operative video demonstrating our surgical technique is provided. Results Magnetic resonance imaging of the brain revealed a rim-enhancing, diffusion-restricting sellar lesion concerning for abscess. No sinus disease or other structural cause of intracranial infection was identified. An endoscopic transsphenoidal approach was used to visualize the endonasal structures, and microscopic guidance was used for evacuation of the abscess. Purulent material was drained immediately upon entry into the lesion. Tissue cultures grew Cutibacterium acnes . Postoperatively, the patient was hypocortisolemic but otherwise endocrinologically normal. She was discharged four days later on oral hydrocortisone and intravenous ceftriaxone without any neurologic deficit. Conclusion To the best of our knowledge, this is the second report in the literature of a primary pituitary abscess due to C. acnes infection.