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Vol. 33. Issue 2.
Pages 99-104 (March - April 2022)
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Vol. 33. Issue 2.
Pages 99-104 (March - April 2022)
Case Report
A rare case of a secondary pituitary abscess arising in a craniopharyngioma with atypical presentation and clinical course
Un caso raro de absceso hipofisario secundario derivado de un craneofaringioma con presentación y evolución clínica atípicas
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Patricia López Gómeza,
Corresponding author
patricia91lpz@gmail.com

Corresponding author.
, David Mato Mañasa, Carlos Bucheli Peñafiela, Eloy Manuel Rodríguez Rodríguezb, Fernando Antonio Pazos Toralc, Sergio Obeso Aguerad, Jaime Viera Artilesd, Geanella Yange Zambranoe, Enrique Marco de Lucasf, Rubén Martín Láeza
a Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain
b Department of Neurology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
c Department of Endocrinology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
d Department of Otorhinolaryngology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
e Department of Pathologic Anatomy, Hospital Universitario Marqués de Valdecilla, Santander, Spain
f Department of Neurorradiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Table 1. Previous published cases. F: female; M: male; HD: hormone deficits; VA: visual alterations.
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.

Keywords:
Craniopharyngioma
Hypopituitarism
Pituitary abscess
Transsphenoidal surgery
Resumen

Los abscesos hipofisarios son infrecuentes. Se pueden dividir en primarios o secundarios, si se producen sobre una lesión previa. Presentamos el octavo caso de un absceso asentado sobre un craneofaringioma.

Una mujer de 59 años consultó por fiebre y cefalea de tres semanas de evolución. La exploración física era anodina. Una resonancia magnética (RMN) evidenció una lesión hipofisaria sugestiva de un proceso inflamatorio crónico. Finalmente, se diagnosticó de una meningitis linfocítica e hipofisitis y se trató con corticoides. Dos meses después reconsultó por los mismos síntomas. En la RMN se evidenció crecimiento de la lesión, por lo que se biopsia endoscópicamente. Durante el procedimiento salió pus. En el examen histológico se evidenció un craneofaringioma y una inflamación meníngea. Se iniciaron antibióticos empíricamente. En el seguimiento a tres meses, la RMN evidenciaba un dudoso resto.

Los abscesos hipofisarios secundarios son raros y hay que tener un alto índice de sospecha para diagnosticarlos. El tratamiento se basa en antibioterapia y evacuación transesfenoidal. Aunque los síntomas se suelen resolver, las endocrinopatías no.

Palabras clave:
Craneofaringioma
Hipopituitarismo
Absceso hipofisario
Cirugía transesfenoidal

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