Cryptogenic pituitary abscess: Two case reports from Indonesia highlighting diagnostic challenges and atypical clinical-radiological features
Background: Pituitary abscess is a rare and diagnostically challenging condition, as it often resembles pituitary adenoma in clinical, laboratory, and radiological features. Unlike typical adenomas, abscesses may present with mild and nonspecific signs of infection or hormonal disturbances. This rep...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-06-01
|
| Series: | Interdisciplinary Neurosurgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751925000696 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849734164573585408 |
|---|---|
| author | Donny Wisnu Wardhana Farhad Balafif Tommy Alfandy Nazwar Fachriy Balafif Ibrahim Yusuf Nasution Saddam Husein Saputra Koernia Hezkia Yonathan Anisa Nur Kholipah |
| author_facet | Donny Wisnu Wardhana Farhad Balafif Tommy Alfandy Nazwar Fachriy Balafif Ibrahim Yusuf Nasution Saddam Husein Saputra Koernia Hezkia Yonathan Anisa Nur Kholipah |
| author_sort | Donny Wisnu Wardhana |
| collection | DOAJ |
| description | Background: Pituitary abscess is a rare and diagnostically challenging condition, as it often resembles pituitary adenoma in clinical, laboratory, and radiological features. Unlike typical adenomas, abscesses may present with mild and nonspecific signs of infection or hormonal disturbances. This report aims to analyse the clinical manifestations, diagnosis, risk factors for abscess formation, and management of this condition in our two patients, as well as cases reviewed from the literature. Case presentation: Both patients were female, presenting with complaints of headache and visual disturbances, including bitemporal hemianopia caused by optic chiasm compression. Laboratory tests revealed elevated FT4 in patient 1 and hyperprolactinemia in patient 2, without systemic signs of infection such as leukocytosis (white blood cell count normal). MRI demonstrated rim-enhancing sellar lesions with central hypointensity and optic chiasm compression, findings highly suggestive of abscess rather than typical pituitary adenoma. Both patients underwent endonasal transsphenoidal hypophysectomy and received antibiotic therapy. The surgical procedure successfully removed the abscess with minimal complications, although the underlying infectious cause remained unidentified. Metronidazole and ceftriaxone therapy proved effective in improving the patients’ prognosis. The results demonstrated a favourable short-term prognosis; however, follow-up evaluation at three months revealed challenges in long-term management. Conclusion: This finding differs from previous literature reports, none of which documented recurrence. We emphasize the importance of a thorough medical history and a multidisciplinary approach to optimize outcomes. Long-term radiological and clinical monitoring is essential for detecting potential recurrence or complications. |
| format | Article |
| id | doaj-art-dbdba9a6009e4ecdb08a0406d95af2cd |
| institution | DOAJ |
| issn | 2214-7519 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj-art-dbdba9a6009e4ecdb08a0406d95af2cd2025-08-20T03:07:51ZengElsevierInterdisciplinary Neurosurgery2214-75192025-06-014010205710.1016/j.inat.2025.102057Cryptogenic pituitary abscess: Two case reports from Indonesia highlighting diagnostic challenges and atypical clinical-radiological featuresDonny Wisnu Wardhana0Farhad Balafif1Tommy Alfandy Nazwar2Fachriy Balafif3Ibrahim Yusuf Nasution4Saddam Husein Saputra5Koernia Hezkia Yonathan6Anisa Nur Kholipah7Division of Neurosurgery, Department of Surgery, Universitas Brawijaya/Saiful Anwar General Hospital, Malang, Indonesia; Corresponding author at: Division of Neurosurgery, Department of Surgery, Universitas Brawijaya/Saiful Anwar General Hospital, Malang, Indonesia.Division of Neurosurgery, Department of Surgery, Universitas Brawijaya/Saiful Anwar General Hospital, Malang, IndonesiaDivision of Neurosurgery, Department of Surgery, Universitas Brawijaya/Saiful Anwar General Hospital, Malang, IndonesiaDivision of Neurosurgery, Department of Surgery, Universitas Brawijaya/Saiful Anwar General Hospital, Malang, IndonesiaDivision of Neurosurgery, Department of Surgery, Universitas Brawijaya/Saiful Anwar General Hospital, Malang, IndonesiaDepartement of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Surabaya, IndonesiaDivision of Neurosurgery, Department of Surgery, Universitas Brawijaya/Saiful Anwar General Hospital, Malang, IndonesiaDivision of Neurosurgery, Department of Surgery, Universitas Brawijaya/Saiful Anwar General Hospital, Malang, IndonesiaBackground: Pituitary abscess is a rare and diagnostically challenging condition, as it often resembles pituitary adenoma in clinical, laboratory, and radiological features. Unlike typical adenomas, abscesses may present with mild and nonspecific signs of infection or hormonal disturbances. This report aims to analyse the clinical manifestations, diagnosis, risk factors for abscess formation, and management of this condition in our two patients, as well as cases reviewed from the literature. Case presentation: Both patients were female, presenting with complaints of headache and visual disturbances, including bitemporal hemianopia caused by optic chiasm compression. Laboratory tests revealed elevated FT4 in patient 1 and hyperprolactinemia in patient 2, without systemic signs of infection such as leukocytosis (white blood cell count normal). MRI demonstrated rim-enhancing sellar lesions with central hypointensity and optic chiasm compression, findings highly suggestive of abscess rather than typical pituitary adenoma. Both patients underwent endonasal transsphenoidal hypophysectomy and received antibiotic therapy. The surgical procedure successfully removed the abscess with minimal complications, although the underlying infectious cause remained unidentified. Metronidazole and ceftriaxone therapy proved effective in improving the patients’ prognosis. The results demonstrated a favourable short-term prognosis; however, follow-up evaluation at three months revealed challenges in long-term management. Conclusion: This finding differs from previous literature reports, none of which documented recurrence. We emphasize the importance of a thorough medical history and a multidisciplinary approach to optimize outcomes. Long-term radiological and clinical monitoring is essential for detecting potential recurrence or complications.http://www.sciencedirect.com/science/article/pii/S2214751925000696Bitemporal hemianopiaCase reportCryptogenicPituitary abscessRare case |
| spellingShingle | Donny Wisnu Wardhana Farhad Balafif Tommy Alfandy Nazwar Fachriy Balafif Ibrahim Yusuf Nasution Saddam Husein Saputra Koernia Hezkia Yonathan Anisa Nur Kholipah Cryptogenic pituitary abscess: Two case reports from Indonesia highlighting diagnostic challenges and atypical clinical-radiological features Interdisciplinary Neurosurgery Bitemporal hemianopia Case report Cryptogenic Pituitary abscess Rare case |
| title | Cryptogenic pituitary abscess: Two case reports from Indonesia highlighting diagnostic challenges and atypical clinical-radiological features |
| title_full | Cryptogenic pituitary abscess: Two case reports from Indonesia highlighting diagnostic challenges and atypical clinical-radiological features |
| title_fullStr | Cryptogenic pituitary abscess: Two case reports from Indonesia highlighting diagnostic challenges and atypical clinical-radiological features |
| title_full_unstemmed | Cryptogenic pituitary abscess: Two case reports from Indonesia highlighting diagnostic challenges and atypical clinical-radiological features |
| title_short | Cryptogenic pituitary abscess: Two case reports from Indonesia highlighting diagnostic challenges and atypical clinical-radiological features |
| title_sort | cryptogenic pituitary abscess two case reports from indonesia highlighting diagnostic challenges and atypical clinical radiological features |
| topic | Bitemporal hemianopia Case report Cryptogenic Pituitary abscess Rare case |
| url | http://www.sciencedirect.com/science/article/pii/S2214751925000696 |
| work_keys_str_mv | AT donnywisnuwardhana cryptogenicpituitaryabscesstwocasereportsfromindonesiahighlightingdiagnosticchallengesandatypicalclinicalradiologicalfeatures AT farhadbalafif cryptogenicpituitaryabscesstwocasereportsfromindonesiahighlightingdiagnosticchallengesandatypicalclinicalradiologicalfeatures AT tommyalfandynazwar cryptogenicpituitaryabscesstwocasereportsfromindonesiahighlightingdiagnosticchallengesandatypicalclinicalradiologicalfeatures AT fachriybalafif cryptogenicpituitaryabscesstwocasereportsfromindonesiahighlightingdiagnosticchallengesandatypicalclinicalradiologicalfeatures AT ibrahimyusufnasution cryptogenicpituitaryabscesstwocasereportsfromindonesiahighlightingdiagnosticchallengesandatypicalclinicalradiologicalfeatures AT saddamhuseinsaputra cryptogenicpituitaryabscesstwocasereportsfromindonesiahighlightingdiagnosticchallengesandatypicalclinicalradiologicalfeatures AT koerniahezkiayonathan cryptogenicpituitaryabscesstwocasereportsfromindonesiahighlightingdiagnosticchallengesandatypicalclinicalradiologicalfeatures AT anisanurkholipah cryptogenicpituitaryabscesstwocasereportsfromindonesiahighlightingdiagnosticchallengesandatypicalclinicalradiologicalfeatures |