Pituitary Abscess Causing Hypopituitarism in a Patient With Acquired Immunodeficiency Syndrome

Pituitary abscess is an uncommon infectious process, comprising <1% of pituitary pathology; however, it can be challenging to diagnose and treat.

A 46-year-old woman with acquired immunodeficiency syndrome (AIDS) presented with headaches, nausea, and visual disturbances. Imaging revealed a sellar mass with peripheral wall enhancement. She was found to have panhypopituitarism. A diagnosis of pituitary abscess was made based on the patient's presentation and imaging results. She was started on broad-spectrum antibiotics, corticosteroids, and thyroid hormone, with improvement of her symptoms and imaging results. Surgery was not performed given the patient's immunocompromised state and improvement with medical therapy.

Infection spread from neighboring structures is a common cause of pituitary abscess, and such infections can occur after surgery or head trauma. Pituitary abscesses can be difficult to distinguish from other lesions; however, rim enhancement is one of the classic findings. Pituitary dysfunction is common, with secondary adrenal insufficiency and diabetes insipidus being the most common hormonal deficiencies found. In addition to antibiotic therapy, the transsphenoidal debridement approach has been the most common route of treatment.

We present a case of pituitary abscess in a patient with AIDS, which likely developed after the patient sustained head trauma. Our patient presented with evidence of panhypopituitarism, requiring emergency treatment. Antibiotic therapy alone was used for treatment. She had to complete a 6-week course of a broad-spectrum antibiotic regimen because the culprit organism could not be identified. Given her posttreatment imaging studies, pituitary function recovery was unlikely because the pituitary gland was completely compromised.