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Hypothalamic-pituitary fungal infection causing panhypopituitarism
The Medical Journal of Malaysia
|July 26, 2021
Summary
Fungal pituitary abscesses can mimic sellar masses, causing vision loss and panhypopituitarism. Early diagnosis via imaging and biopsy is crucial for effective antifungal and surgical treatment.
Area of Science:
- Endocrinology
- Neurosurgery
- Ophthalmology
Background:
- Pituitary infections can present as sellar masses, leading to symptoms like vision impairment and panhypopituitarism.
- Differentiating fungal pituitary abscesses from other sellar lesions is critical for appropriate management.
Observation:
- A 69-year-old female presented with progressive vision loss, orbital swelling, and panhypopituitarism, initially suspected as a sellar mass.
- MRI revealed a sellar mass with suprasellar extension; biopsy identified a fungal infection (Candida species).
Findings:
- Despite initial antifungal and hormonal therapy, the lesion enlarged, necessitating further debulking surgery and a ventriculoperitoneal shunt.
- Histopathological examination confirmed a chronic inflammatory process consistent with fungal infection.
Implications:
- This case highlights the importance of considering pituitary infections in the differential diagnosis of sellar masses.
- Optimal management involves a combination of surgical debulking and targeted antifungal therapy for fungal pituitary abscesses.
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