Pituitary Awareness Month 2019

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PNA Medical Corner: Pituitary Abscess After Endoscopic Endonasal Surgery

Fred GentileThis month the PNA Medical Corner spotlights an article co-authored by Dr. Fred Gentili of the University of Toronto, a PNA member. The research looks at the treatment of a woman who had to have two endoscopic endonasal surgeries, because an abscess developed after the first one, and pus had to be drained.

Pituitary abscess following endoscopic endonasal drainage of a suprasellar arachnoid cyst: Case report and review of the literature.
Ovenden CD1, Almeida JP2, Oswari S2, Gentili F2.
J Clin Neurosci. 2019 Aug 8. pii: S0967-5868(19)30270-X. doi: 10.1016/j.jocn.2019.07.081. [Epub ahead of print] Review.
PMID: 31402262
J Clin Neurosci. 2019 Aug 8. pii: S0967-5868(19)30270-X. doi: 10.1016/j.jocn.2019.07.081. [Epub ahead of print]

Author Information

1Adelaide Medical School, University of Adelaide, Adelaide, Australia. Electronic address: [email protected]
2Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Toronto, ON, Canada.

Abstract

Arachnoid cysts are uncommon lesions of the sellar region, and only rarely require decompressive surgery to treat symptoms. Pituitary abscesses are another rare lesion, and are an uncommon complication of pituitary surgery. A previously healthy 45 year old woman presented with a new finding of bitemporal hemianopsia. Magnetic resonance imaging (MRI) showed a cystic sellar lesion with suprasellar extension and compression of the optic chiasm. Endoscopic transsphenoidal surgery was performed and the lesion was found to be an arachnoid cyst. She was well immediately after the operation, but 1 week later presented with headaches, fever and worsening visual acuity. MRI showed a homogenous collection in the sellar region that was compressing the chiasm. The patient was treated with antibiotics, and a second transsphenoidal operation was performed, with frank pus found in the pituitary fossa. Cultures of the fluid found during the operation grew Escherichia coli and Staphylococcus lugdunensis. Her symptoms resolved after the second operation, and formal visual fields and a pituitary hormone panel were normal at this time. We report on a rare case of a pituitary abscess complicating surgery for a sellar arachnoid cyst, and discuss management of these conditions.

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