CASE REPORT AND LITERATURE REVIEW Pituitary abscess: our experience with a case and a review of the literature Rinkoo Dalan Æ Melvin Khee Shing Leow Published online: 27 June 2007 Ó Springer Science+Business Media, LLC 2007 Abstract Pituitary abscess is a rare disease. Due to its potentially high mortality and morbidity rate, it should be considered in the differential diagnosis of sellar masses. Despite recent advances in radiological investigations, making a definitive diagnosis preoperatively remains challenging. This 45-year-old Indian gentleman presented with severe throbbing headache for six months. Magnetic resonance imaging of the brain revealed a sellar mass with peripheral enhancement that was misdiagnosed as a pitui- tary macroadenoma. A trans-sphenoidal excision was done, which surprisingly yielded only pus that was drained accordingly from the lesion. Fungal and bacterial cultures were negative. However this patient subsequently lost complete function of the pituitary gland, resulting in cen- tral diabetes insipidus and required permanent hormonal replacement therapy in the deficient endocrine axes. A Medline search was conducted and a review of 24 cases reported in the last 5 years discussed. Keywords Pituitary abscess Á Pituitary adenoma Á Panhypopituitarism Á Central Diabetes Insipidus Introduction Primary pituitary abscess is a rare but potentially life threatening disease. Our patient presented with severe throbbing headache for six months. Magnetic reso- nance imaging (MRI) of the brain showed a sellar mass with peripheral enhancement, which was misdiagnosed as a pituitary macroadenoma. A trans-sphenoidal excision was done, which surprisingly yielded copious purulent exudate that was drained accordingly. Fungal and bacterial cultures were negative. Unfortunately, this patient subsequently lost complete function of the pituitary gland and required life- long multiple hormonal replacement therapy. Case report This 45-year-old Indian gentleman presented to his general practitioner with complaints, of recurrent localized frontal throbbing headaches for about 6 months requiring parac- etamol for amelioration. A brain MRI showed a sellar mass with peripheral enhancement. He was referred to the neu- rosurgeons for further management. After discussion with the patient it was decided to observe the mass with repeat imaging after six months. He was referred to our endocri- nology service for the assessment of tumor functionality. He had been previously healthy. He had no polyuria, polydipsia or nocturia, and experienced no sexual dys- function. There was neither visual disturbance dysgeusia nor anosmia. Fever was notably absent, as were other systemic complains or generalized illness. Apart from paracetamol, he had taken multiple courses of antibiotics for recurrent sinusitis. He was married at the age of 29 years and fathered a daughter. He had been smoking about 10 cigarettes daily for 20 years and drank alcohol socially. He had a family history of type 2-diabetes- mellitus but had no history of pituitary problems. He was afebrile with a temperature of 37.2°C. His weighed 80.6 kg and was 1.68 m tall with a BMI of 28.5. His blood pressure was 120/74 mm Hg with no postural drop. He was not cushingoid, acromegalic or eunuchoid. Secondary sexual characteristics were preserved. There R. Dalan (&) Á M. K. S. Leow Department of Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore e-mail: rinkoo99@yahoo.com 123 Pituitary (2008) 11:299–306 DOI 10.1007/s11102-007-0057-3