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Background/Objective: Pituitary abscess is an uncommon life-threatening disease that could lead to panhypopituitarism. It is important to suspect its prevalence in regions with endemic infectious diseases. Case Report: A 55-year-old man, a farmer, with a background of consumption of unpasteurized dairy products, presented with headache, impaired consciousness, and fever that started in February 2023. Initial test results were consistent with neuroinfection. Brain MRI showed ventriculitis; the pituitary gland was heterogeneous with the presence of an 8 × 8 mm abscess. The pituitary hormone axis was evaluated, and it showed results compatible with the results of panhypopituitarism with central hypothyroidism, central hypocortisolism, central hypogonadism, and growth hormone deficiency. Hormone replacement treatment with hydrocortisone and levothyroxine was started. The Rose Bengal test for Brucella spp. and 2-mercaptoethanol Brucella agglutination test showed positive results. After neurobrucellosis (NB) was diagnosed, antibiotic treatment was commenced. The patient was discharged 6 weeks later and treatment with prednisone, levothyroxine, recombinant somatropin, testosterone, as well as doxycycline, and rifampin was continued for another 4 months. Discussion: NB and pituitary abscess are rare manifestations of brucellosis and are challenging to diagnose due to their nonspecific clinical presentation and cerebrospinal fluid (CSF) findings. NB diagnosis relies on neurologic symptoms and serological evidence of Brucella infection. Magnetic resonance imaging is the preferred diagnostic tool for pituitary abscesses. Medical management may be sufficient, while transsphenoidal drainage is not always necessary. Hormonal deficits typically remain permanent. Conclusion: Pituitary abscess could be suspected in patients presenting with symptoms of neuroinfection, panhypopituitarism, and heterogenous image in the magnetic resonance imaging differential diagnosis. Opportune management can lead to reduced mortality and improved recovery of the pituitary hormone function.
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PURPOSE: Pituitary abscesses (PAs) are a rare clinical entity which may arise from normal pituitary tissue or underlying lesions within the gland. Rathke's cleft cysts (RCCs) are not commonly associated with the development of PA. METHODS: Retrospective chart review of three patients with PAs within RCCs at a single university center and review of the literature. RESULTS: Three cases are reported. The first case presented with fever and headache and a history of prior surgery due to RCC and a recent respiratory tract infection. The second case had a history of recent skin infections and presented with sudden onset headache and hypopituitarism. In the third case, chronic visual field impairment prompted an ophthalmologic evaluation resulting in a diagnosis of an adenoma and an infected RCC. In all three cases, an endoscopic endonasal approach was performed to drain infected tissue and allowed microbiological identification of gram-positive cocci, followed by treatment with antibiotics for at least three weeks. Cases in the literature are scarce and the diagnosis is usually made intraoperatively due to non-specific manifestations and imaging. PAs arising from underlying pituitary lesions are less common than primary PAs. Differential diagnosis should include pituitary apoplexy, hypophysitis and other cystic lesions. CONCLUSION: PAs occurring in RCCs are infrequent. Clinical manifestations are commonly subacute, without septic symptoms. Imaging is usually non-specific. Preoperative diagnosis is infrequent and a broad differential diagnosis should be considered. Empirical antimicrobial therapy should be initiated and adjusted after obtaining cultures to reduce the rate of recurrence and improve clinical outcomes.
Assuntos
Carcinoma de Células Renais , Cistos do Sistema Nervoso Central , Neoplasias Renais , Doenças da Hipófise , Neoplasias Hipofisárias , Abscesso , Cistos do Sistema Nervoso Central/diagnóstico , Cistos do Sistema Nervoso Central/cirurgia , Cefaleia , Humanos , Doenças da Hipófise/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Estudos RetrospectivosRESUMO
Resumen: El absceso de hipófisis es una enfermedad poco frecuente, constituye menos del 1% de la patología selar, con alta dificultad diagnóstica, clínica poco orientadora, imagenología inespecífica y necesidad de cirugía diagnóstico-terapéutica en gran número de casos. Se denominan primarios cuando asientan en una glándula sana, y secundarios cuando la misma tiene una enfermedad preexistente. La infección se desarrolla por vía hematógena, por contigüidad o por mecanismos no evidentes. La resolución debe ser urgente ya que el curso es impredecible. Se presentan dos casos clínicos asistidos en el transcurso de un año y se realiza revisión de la literatura.
ABSTRACT: Pituitary abscess is a rare disease, is less than 1% of the sellar pathology, with high diagnostic difficulty, little clinical counselor, nonspecific imaging and diagnostic- therapeutic need surgery in many cases. Are called primary when seated in a healthy, and secondary when the same side gland has a preexisting condition. The infection develops through the blood, contiguous or non-obvious mechanisms. The resolution must be urgently because the course is rarely. Two cases assisted in the course of a year and review of the literature is presented.
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Los abscesos hipofisarios se diagnostican en la mayoría de los casos solo después del drenaje transesfenoidal, el abordaje terapéutico de elección; son subdiagnosticados y representan una enfermedad con alta mortalidad sin el tratamiento correcto y oportuno. Este es el caso clínico de una paciente de 38 años de edad con amenorrea de un año de evolución, galactorrea, cefalea y déficit campimétrico manifestado por hemianopsia bitemporal. La resonancia magnética nuclear mostró una imagen compatible con adenoma hipofisario, por lo que se realizó abordaje transesfenoidal confirmándose por reporte histopatológico un absceso cerebral. Se llevó terapia antibiótica empírica con vancomicina, metronidazol y ceftriaxona a dosis meníngeas, sin obtener el agente causal en los cultivos. Se concluyó que los abscesos hipofisiarios son una patología potencialmente curable que al manifestarse como una masa selar la gran mayoría recibe un abordaje terapéutico adecuado por vía transesfenoidal, y en la mayoría de los casos dicho procedimiento arroja el diagnóstico y el tratamiento definitivo al mismo tiempo.
Pituitary abscesses are defined as the affection of the pituitary gland by an intrasellar suppurative process caused by an infectious agent. Pituitary abscesses represent less than 1% of the pathologies of the sellar region, the clinical manifestations are due to pituitary dysfunction or mass effect. The diagnosis in most of the cases is only after transsphenoidal drainage which is the therapeutic approach of choice, being underdiagnosed and becoming a disease with high mortality if the right and appropriate treatment is not instituted. Case report. A case of a 38-year-old-female patient with amenorrhea of one year of evolution, galactorrhea, headache and visual field deficits manifested by bitemporal hemianopsia is reported. Magnetic resonance imaging showed an image compatible with pituitary adenoma, a transsphenoidal approach was performed and histopathologic report confirmed a brain abscess. Antibiotic therapy was empirically started with vancomycin, metronidazole and ceftriaxone at meningeal doses, failed to get the agent in cultures. Conclusions. Pituitary abscesses are a potentially curable disease that present as a sellar mass, most receive the appropriate therapy by transsphenoidal approach and in most of the cases this procedure gives the definitive diagnosis and treatment simultaneously.
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Para determinar as doenças que ocorrem no sistema nervoso de bovinos no semiárido nordestino, foi realizado um estudo retrospectivo em 411 necropsias de bovinos realizadas no Hospital Veterinário da Universidade Federal de Campina Grande, Patos, Paraíba, entre janeiro de 2000 a dezembro de 2008. Dos 411 casos analisados 139 (33,81 por cento) apresentaram alterações clínicas do sistema nervoso e as fichas foram revisadas para determinar os principais achados referentes à epidemiologia, aos sinais clínicos e às alterações macroscópicas e microscópicas. Em 28 (20,14 por cento) casos o diagnóstico foi inconclusivo. As principais enfermidades foram raiva (48,7 por cento dos casos com sinais nervosos), abscessos cerebrais (7,2 por cento) incluindo três casos de abscesso da pituitária, febre catarral maligna (6,3 por cento), botulismo (6,3 por cento), alterações congênitas (4,5 por cento), traumatismo (4,5 por cento), tuberculose (2,7 por cento), tétano (2,7 por cento), infecção por herpesvírus bovino-5 (2,7 por cento), encefalomielite não supurativa (2,7 por cento), intoxicação por Prosopis juliflora (2,7 por cento), status spongiosus congênito de causa desconhecida (1,8 por cento) e polioencefalomalacia (1,8 por cento). Outras doenças diagnosticadas numa única oportunidade (0,9 por cento) foram criptococose, listeriose, encefalite tromboembólica, linfossarcoma, tripanossomíase e babesiose por Babesia bovis.
Diseases of the nervous system of cattle in the semiarid region of northeastern Brazil were evaluated by a retrospective study of 411 cattle necropsies performed in the Veterinary Hospital of the Federal University of Campina Grande, Patos, Paraíba, from January 2000 to December 2008. Of the 411 cases analyzed, 139 (33.81 percent) were from cattle that presented nervous signs and the records were reviewed to determine the epidemiological, clinical, and macroscopic and histologic main features. Diagnosis was inconclusive in 28 cases (20.14 percent). In cases with diagnosis the main diseases were rabies (48.7 percent of the cases with nervous signs), brain abscesses (7.2 percent) including three cases of pituitary abscesses, malignant catarrhal fever (6.3 percent), botulism (6.3 percent), congenital malformations (4.5 percent), trauma (4.5 percent), tuberculosis (2.7 percent), tetanus (2.7 percent), infection by bovine hervesvirus-5 (2.7 percent), non-suppurative encephalomyelitis (2.7 percent), intoxication by Prosopis juliflora (2.7 percent), congenital status spongiosus of unknown etiology (1.8 percent), and polioencephalomalacia (1.8 percent). Other diseases diagnosed only once (0.9 percent) were cryptococcosis, listeriosis, thromboembolic encephalitis, lymphosarcoma, trypanosso-miasis, and babesiosis by Babesia bovis.