Infectious disease in the sella turcica

Intrasellar infection is characterized by pituitary dysfunction and damage to surrounding structures. In most cases patients have fever, headache, and visual disturbance and exhibit roentgenographic evidence of a mass. Suppurative infections may originate in the paranasal sinuses, meninges, or more distant foci and are commonest in the setting of preexisting pituitary adenomata. Pituitary tuberculosis may arise from hematogenous spread or extension of local lesions and may be confused with a variety of other granulomatous diseases. Congenital and acquired syphilis of the pituitary are more often diagnosed at autopsy or by the concurrence of pituitary dysfunction and serologic evidence of syphilis. Although viral infection may be associated with pituitary or hypothalamic dysfunction, overt hypophyseal infection is rarely documented. In contrast, a variety of parasites and fungi have been found in pituitary tissue. The diagnosis of pituitary infection should be considered when signs of intrasellar mass or pituitary dysfunction are accompanied by fever and other evidence of infection.