A rare case of a secondary pituitary abscess arising in a craniopharyngioma with atypical presentation and clinical course |
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| Institution: | 1. Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain;2. Department of Neurology, Hospital Universitario Marqués de Valdecilla, Santander, Spain;3. Department of Endocrinology, Hospital Universitario Marqués de Valdecilla, Santander, Spain;4. Department of Otorhinolaryngology, Hospital Universitario Marqués de Valdecilla, Santander, Spain;5. Department of Pathologic Anatomy, Hospital Universitario Marqués de Valdecilla, Santander, Spain;6. Department of Neurorradiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain;1. Área de Praxis, Servicio de Responsabilidad Profesional, Colegio de Médicos de Barcelona, Consejo de Colegios de Médicos de Catalunya, Barcelona, España;2. Cátedra de Responsabilidad Profesional Médica y Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, España;3. Facultad de Medicina, Universitat Internacional de Catalunya, Barcelona, España;1. Hospital Universitario Ramón y Cajal, Department of Endocrinology & Nutrition, Neuroendocrinology Unit, and Instituto Ramón & Cajal de Investigación Biomédica (IRYCIS), Madrid, Spain;2. Hospital Universitario Ramón y Cajal, Otorhinolaryngology Department, Rhinology and Skull Base Surgery Unit, Madrid, Spain;3. Hospital HM Puerta del Sur, Otorhinolaryngology Department, Rhinology and Skull Base Surgery Unit, Madrid, Spain;4. Hospital Universitario Ramón y Cajal, Department of Neurosurgery, Pituitary Surgery Unit, Madrid, Spain;5. Hospital HM Puerta del Sur, Department of Neurosurgery, Pituitary Surgery Unit, Madrid, Spain;1. Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España;2. Servicio de Cirugía General, Hospital Universitario La Paz, Madrid, España;3. Neurofisiología Clínica, Servicio de Neurología, Hospital Universitario La Paz, Madrid, España;1. Department of Internal Medicine Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey;2. Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey;3. Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey;4. Department of Radiation Oncology, Marmara University School of Medicine, Istanbul, Turkey;1. Department of Neurosurgery, University Hospital Complex of Vigo, Pontevedra, Spain;2. Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Pontevedra, Spain;3. Department of Neurosurgery, Hospital Universitari Arnau de Vilanova, Lleida, Spain |
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| Abstract: | Pituitary abscesses are very uncommon. They are divided into primary, arising within a healthy gland, and secondary, observed with an underlying pre-existing lesion. Here we present the eighth case reported of a secondary abscess within a craniopharyngioma.A 59-year-old-woman presented with a 3-week history of headache, and fever. Physical examination was unremarkable. An Magnetic Resonance Imaging (MRI) showed a pituitary lesion suggestive of a chronic inflammatory process. She was diagnosed with lymphocytic meningitis with hypophysitis and she was treated with corticosteroids. Two months later she presented with headache and fever again. Control MRI showed enlargement of the pituitary lesion. Therefore, a transsphenoidal biopsy was performed. During the procedure, purulent material was released. Histological study demonstrated a craniopharyngioma and meningeal inflammation. Empiric antibiotics were started. Three months post-operatively, a follow-up MRI showed a suspect minimal residual mass.Secondary pituitary abscesses are rare. The key to successful management is a high index of suspicion. Transsphenoidal surgical evacuation plus antibiotics is the mainstay of treatment. Although most symptoms resolve, endocrinopathies improve only rarely. |
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| Keywords: | Craniopharyngioma Hypopituitarism Pituitary abscess Transsphenoidal surgery Craneofaringioma Hipopituitarismo Absceso hipofisario Cirugía transesfenoidal |
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