Related Experiment Video
Updated: Feb 23, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Spontaneous rupture of a secondary pituitary abscess causing acute meningoencephalitis: Case report and literature
Giovanni Muscas1,2, Francesco Iacoangeli3,2, Laura Lippa3,2
1Department of Neurosurgery, Careggi Hospital, Florence, Italy.
Background:
Pituitary abscess (PA) is an uncommon finding that is rarely diagnosed preoperatively. If not properly treated it is associated with high morbidity and mortality rates. Nowadays standard diagnostic procedures allow early detection and successful treatment of this lesion in a high number of cases and mortality has been significantly reduced in recent years. PA arising de novo in a healthy gland are defined as primary, whereas those complicating a pre-existing disease of the hypophysis are called secondary abscesses.
Case Description:
We present a case of a secondary PA mimicking a large pituitary adenoma extending in the nasal cavity, which was wrongly diagnosed as such. The abscess showed an unexpected evolution in 48 h from presentation due to a sudden, extensive intracranial leakage of pus.
Conclusions:
To our knowledge, it is rare to find PA showing a rapid evolution like this, and in the literature only one previous case of a PA not reaching medical or surgical therapy was reported. In that case, hypothalamus involvement was identified as the cause of death. This should be the first case reported of a spontaneous PA rupture causing acute meningoencephalitis. Along with a short review of the literature on the major features of PA, we also tried to identify some features which could be supportive of a diagnosis of secondary PA.
Insights
Pituitary abscess (PA) is a rare condition, often misdiagnosed. This case highlights a secondary PA with rapid intracranial leakage, leading to meningoencephalitis, emphasizing the need for early diagnosis and treatment.
Area of Science:
- Neuroendocrinology
- Neurosurgery
- Infectious Diseases
Background:
- Pituitary abscess (PA) is an uncommon endocrine disorder with high morbidity and mortality if not treated promptly.
- Primary PAs arise de novo, while secondary PAs complicate pre-existing pituitary diseases.
- Modern diagnostics improve early detection and treatment, significantly reducing mortality rates.
Observation:
- A secondary pituitary abscess mimicked a large pituitary adenoma with nasal extension, leading to misdiagnosis.
- The abscess exhibited rapid intracranial leakage of pus within 48 hours of presentation.
- This case represents a spontaneous pituitary abscess rupture causing acute meningoencephalitis.
Findings:
- The case details a rare, rapidly evolving secondary pituitary abscess.
- Literature review indicates limited reported cases of PA with rapid progression or spontaneous rupture.
- Hypothalamus involvement was previously identified as a cause of death in a similar untreated case.
Implications:
- This case underscores the importance of considering pituitary abscess in differential diagnoses, even with atypical presentations.
- Prompt diagnosis and intervention are crucial for improving outcomes in pituitary abscess cases.
- Identifying features supportive of secondary PA can aid in timely and accurate diagnosis, potentially preventing severe complications like meningoencephalitis.
