Year 2020 Vol. 28 No 2

CASE REPORTS

V.A. ZHURAULIOU 1, K.M. KUBRAKOV 2, S.T. AKMYRADOV 3

PITUITARY ABSCESS

Belarusian Medical Academy of Postgraduate Education1, Minsk,
Vitebsk State Medical University 2, Vitebsk,
Republican Research and Clinical Center of Neurology and Neurosurgery3, Minsk,
The Republic of Belarus

The article presents two clinical observations of a rare pathology pituitary abscess, complicated by the secondary purulent meningitis. Clinical and instrumental examination, as well as hormonal changes indicated a pituitary adenoma. The laboratory tests and magnetic resonance imaging showed no signs of inflammation in the patients body. However, when performing the planned transsphenoidal endoscopic operations, pituitary abscesses were diagnosed. The latter were completely removed, purulent cavities washed with antiseptic solutions. In the first observation, liquorrhea was detected intraoperatively, which required plastic closure of the defect of the Turkish saddle with adhesive compositions. The patient developed secondary purulent meningitis, which was cured by the rational antibacterial therapy. In the second observation, the outflow of the cerebrospinal fluid was not observed intraoperatively. The plastic of the bottom of the Turkish saddle was also made. Antibacterial drugs were prescribed. Both patients were discharged from the hospital, the hormonal background improved. Liquorrhea was not detected during the control examinations. Four months after discharge, the second patient developed secondary purulent meningitis, which required emergency hospitalization. The active tactics of patient management with the use of diagnostic test systems D-lactam and Biolactam allowed quick prescription and correction of effective antibacterial drugs for negative bacteriological analysis. The patient was discharged on the 23rd day without neurologic deficit. These clinical cases are of interest as options for disease-free treatment of rather a rare inflammatory pathology of the pituitary gland.

Keywords: pituitary abscess, meningitis, liquorrhea, antibiotics, beta-lactamase activity, D-lactate
p. 222-232 of the original issue
References
  1. Hanel RA, Koerbel A, Prevedello DM, Moro MS, Araújo JC. Primary pituitary abscess: case report. Arq Neuropsiquiatr. 2002 Sep;60(3-B):861-65. http://dx.doi.org/10.1590/S0004-282X2002000500033
  2. Karagiannis AK, Dimitropoulou F, Papatheodorou A, Lyra S, Seretis A, Vryonidou A. Pituitary abscess: a case report and review of the literature. Endocrinol Diabetes Metab Case Rep. 2016;2016:160014. doi: 10.1530/EDM-16-0014
  3. Giovanni Muscas, Francesco Iacoangeli, Laura Lippa, Biagio R. Carangelo. Spontaneous rupture of a secondary pituitary abscess causing acute meningoencephalitis: Case report and literature review. Surg Neurol Int. 2017;8:177. doi: 10.4103/sni.sni_131_17
  4. Iplikcioglu AC, Bek S, Bikmaz K, Ceylan D, Gökduman CA. Aspergillus pituitary abscess. Acta Neurochir (Wien). 2004 May;146(5):521-24. doi: 10.1007/s00701-004-0256-x
  5. Agyei JO, Lipinski LJ, Leonardo J. Case Report of a Primary Pituitary Abscess and Systematic Literature Review of Pituitary Abscess with a Focus on Patient Outcomes. World Neurosurg. 2017 May;101:76-92. doi: 10.1016/j.wneu.2017.01.077
  6. Kim HC, Kang SG, Huh PW, Yoo do S, Cho KS, Kim DS. Pituitary abscess in a pregnant woman. J Clin Neurosci. 2007 Nov;14(11):1135-39. doi: 10.1016/j.jocn.2006.03.012
  7. Danilowicz K, Sanz CF, Manavela M, Gomez RM, Bruno OD. Pituitary abscess: a report of two cases. Pituitary. 2008;11(1):89-92. doi: 10.1007/s11102-007-0033-y
  8. Kuge A, Sato S, Takemura S, Sakurada K, Kondo R, Kayama T. Abscess formation associated with pituitary adenoma: a case report: Changes in the MRI appearance of pituitary adenoma before and after abscess formation. Surg Neurol Int. 2011 Jan 24;2:3. doi: 10.4103/2152-7806.76140
  9. Jaiswal AK, Mahapatra AK, Sharma MC. Pituitary abscess associated with prolactinoma. J Clin Neurosci. 2004 Jun;11(5):533-34. doi: 10.1016/j.jocn.2003.07.010
  10. Meftah A, Moumen A, Eljadi H, Guerboub AA, Elmoussaoui S, Belmejdoub G. Pituitary abscess simulating a pituitary adenoma. Presse Med. 2016 Jun;45(6 Pt 1):602-4. doi: 10.1016/j.lpm.2016.03.016 [Article in French]
  11. Takayasu T, Yamasaki F, Tominaga A, Hidaka T, Arita K, Kurisu K. A pituitary abscess showing high signal intensity on diffusion-weighted imaging. Neurosurg Rev. 2006 Jul;29(3):246-48. doi: 10.1007/s10143-006-0021-0
  12. Zhang X, Sun J, Shen M, Shou X, Qiu H, Qiao N, Zhang N, Li S, Wang Y, Zhao Y. Diagnosis and minimally invasive surgery for the pituitary abscess: a review of twenty nine cases. Clin Neurol Neurosurg. 2012 Sep;114(7):957-61. doi: 10.1016/j.clineuro.2012.02.020
Address for correspondence:
210023, Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Neurology and Neurosurgery,
Tel.: +375 29 734 93 36,
e-mail: k-kubrakov@yandex.ru,
Konstantin M. Kubrakov
Information about the authors:
Zhurauliou Vladimir A., PhD, Associate Professor, the Department of Neurology and Neurosurgery, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-5269-3406
Kubrakov Konstantin M., PhD, Associate Professor, the Department of Neurology and Neurosurgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-6723-0589
Akmyradov Selimmyrat T., Neurosurgeon, the 1st Neurosurgical Unit, Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Republic of Belarus
https://orcid.org/0000-0002-8917-7245
Contacts | ©Vitebsk State Medical University, 2007-2023