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Title: Pituitary abscess: a case report and systematic review of 488 cases.
Austin Authors: Stringer, Felicity;Foong, Yi Chao;Tan, Alanna ;Hayman, Sarah;Zajac, Jeffrey D ;Grossmann, Mathis ;Zane, Justin Ng Yau;Zhu, Jasmine J ;Ayyappan, Sujith
Affiliation: Barwon Health, Geelong, VIC, Australia.;St Vincent's Health, Melbourne, VIC, Australia.
Monash Health, Melbourne, VIC, Australia.;Alfred Health, Melbourne, VIC, Australia.
Austin Health
Monash University, Melbourne, VIC, Australia.
Eastern Health, Melbourne, VIC, Australia.
Royal Hobart Hospital, Hobart, TAS, Australia.
Issue Date: 26-Jun-2023
Date: 2023
Publication information: Orphanet Journal of Rare Diseases 2023-06-26; 18(1)
Abstract: Pituitary abscess (PA) is a rare condition and not well understood. We aimed to describe a case and perform a comprehensive systematic review to explore presenting symptoms, radiological findings, endocrine abnormalities and mortality. To identify presenting symptoms, radiological findings, endocrinological abnormalities and predictors of mortality for PA. We systematically reviewed the literature to identify all case reports of PA. Data regarding presentation, mortality, radiological findings, endocrinological abnormalities and treatment was extracted. We identified 488 patients from 218 articles meeting the inclusion criteria. Mortality was 5.1%, with days to presentation (OR 1.0005, 95% CI 1.0001-1.0008, p < 0.01) being the only identified independent predictor of mortality. Mortality rates have decreased over time, with cases published prior to 2000 having higher mortality rates (OR 6.92, 95% CI 2.80-17.90, p < 0.001). The most common symptom was headache (76.2%), followed by visual field defects (47.3%). Classical signs of infection were only present in 43%. The most common imaging feature on magnetic resonance imaging (MRI) was high T2 and low T1 signal of the pituitary gland with peripheral contrast enhancement. Over half (54.8%) were culture negative, with the most common bacterial organism being staphylococcus aureus (7.8%) and fungal organism being aspergillus (8.8%). The most common endocrine abnormality was hypopituitarism (41.1%), followed by diabetes insipidus (24.8%). Whilst symptoms resolved in most patients, persistent endocrine abnormalities were present in over half of patients (61.0%). PA is associated with significant mortality, with delayed presentation increasing risk of mortality. Ongoing endocrinological abnormalities are common. Given the non-specific clinical presentation, the appearance of high T2, low T1 and peripheral contrast enhancement of the pituitary on MRI should prompt consideration of this rare disease.
DOI: 10.1186/s13023-023-02788-1
ORCID: 0000-0001-6447-078X
Journal: Orphanet Journal of Rare Diseases
Start page: 165
PubMed URL: 37365629
ISSN: 1750-1172
Type: Journal Article
Subjects: Abscess
Rathke’s cleft cyst
Systematic review
Pituitary Diseases/complications
Pituitary Diseases/diagnosis
Pituitary Diseases/microbiology
Pituitary Neoplasms/complications
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